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Surgical Treatment of Recurrent Pyogenic Cholangitis

Surgical Treatment of Recurrent Pyogenic Cholangitis Abstract Objective: To examine the evolving operative strategies in the treatment of recurrent pyogenic cholangitis (RPC). Design: Case series of patients with RPC treated surgically at the Los Angeles County-University of Southern California Medical Center between 1980 and 1994. Setting: Public teaching hospital. Patients: Twenty patients with RPC were studied. The clinical diagnosis of RPC was made in patients with a syndrome of chronic intermittent attacks of biliary sepsis associated with intrahepatic biliary strictures and intrahepatic stones. Main Outcome Measure: The need for repeated biliary intervention after surgical treatment of RPC. Results: Four patients had a hepatic lobectomy without biliary enteric bypass. One patient had an uneventful course. Three patients had postoperative biliary sepsis, and one of these patients died. A hepaticojejunostomy without a cutaneous stoma was performed in eight patients. Five (63%) of these eight required repeated operation for biliary sepsis 1 to 4 years after surgery. In eight patients, a Rouxen-Y hepaticojejunostomy was performed after attempted clearance of intrahepatic stones with construction of a temporary cutaneous stoma. Postoperatively, these eight patients had 16 transstomal endoscopic cholangiograms (mean follow-up, 10 months). Stones proximal to intrahepatic strictures were identified in seven endoscopic sessions in five of these patients (63%). The stones were removed, and the strictures were endoscopically dilated. None required repeated biliary operation. Conclusion: RPC is a progressive, lifelong disease. Construction of a hepaticojejunostomy with a cutaneous stoma allows future therapeutic intervention without the need for repeated surgery.(Arch Surg. 1995;130:527-533) References 1. Wen CC, Lee HC. Intrahepatic stones: a clinical study . Ann Surg . 1972;175: 166-177.Crossref 2. Carmona RH, Crass RA, Lim RC, Trunkey DD. Oriental cholangitis . Am J Surg . 1984;148:117-124.Crossref 3. Turner WW, Cramer CR. Recurrent Oriental cholangiohepatitis . Surgery . 1983; 93:397-401. 4. Yellin AE, Donovan AJ. Biliary lithiasis and helminthiasis . Am J Surg . 1981; 142:128-136.Crossref 5. Chang TM, Passaro EM. Intrahepatic stones: the Taiwan experience . Am J Surg . 1983;146:241-244.Crossref 6. Choi TK, Wong J. Partial hepatectomy for intrahepatic stones . World J Surg . 1986;10:281-286.Crossref 7. Ong GB. A study of recurrent pyogenic cholangitis . Arch Surg . 1962;84:63-89.Crossref 8. Choi TK, Wong, Ong GB. The surgical management of primary intrahepatic stones . Br J Surg . 1982;69:86-90.Crossref 9. Digby KH. Common duct stones of liver origin . Br J Surg . 1930;17:578-591.Crossref 10. Cobo A, Hall RC, Torres E, Cuello CJ. Intrahepatic calculi . Arch Surg . 1964; 89:936-941.Crossref 11. Simi M, Loriga P, Basoli A, Leardi S, Speranza V. Intrahepatic lithiasis: a study of 36 cases and review of the literature . Am J Surg. 1979;137:317-322.Crossref 12. Shulman A. Non-Western patterns of biliary stones and the role of ascariasis . Radiology . 1987;162:425-430.Crossref 13. Fung J. Liver fluke infestation and cholangio-hepatitis . Br J Surg . 1961;48: 404-415.Crossref 14. Seel Park YY. Oriental infestainal cholangitis . 370. 15. Chou ST, Chan CW. Recurrent pyogenic cholangitis: a necropsy study . Pathology . 1980;12:415-428.Crossref 16. Choi TK. Intrahepatic stones . BrJSurg . 1989;76:213-214. 17. Lim JH, Ko YT, Lee DH, Hong KS, Oriental cholangiohepatitis: sonographic findings in 48 cases . AJR Am J Roentgenol . 1990;155:511-514.Crossref 18. Wong J, Choi TK. Recurrent pyogenic cholangitis . In: Blumgart LH, ed. Surgery of the Liver and Biliary Tract Edinburgh, Scotland: Churchill Livingstone; 1988:977-992. 19. Rails PW, Colletti PM, Quinn MF, Lapin SA, Morris UL, Halls JM. Sonography in recurrent pyogenic cholangitis . AJR Am J Roentgenol . 1981;136:10101012. 20. Feeny PC. Acute pyogenic hepatitis: sonographic and angiographie findings . AJR Am J Roentgenol . 1980;135:388-391.Crossref 21. Chau EMT, Leong LLY, Chan FL. Recurrent pyogenic cholangitis: ultrasound evaluation compared with endoscopie retrograde cholangiopancreatography . Clin Radio! . 1987;35:79-85.Crossref 22. Chan FK, Man SW, Leong LLY, Fan ST. Evaluation of recurrent pyogenic cholangitis: CT analysis of 50 patients . Radiology . 1989;170:165-169.Crossref 23. van Sonnenburg E, Casóla G, Cubberly DA, et al. Oriental cholangiohepatitis: diagnostic imaging and interventional management . AJR Am J Roentgenol . 1986; 146:327-331.Crossref 24. Fan ST, Lai ECS, Wong J. Hepatic resection for hepatolithiasis . Arch Surg . 1993;128:1070-1074.Crossref 25. Shulte SJ, Baron RL, Teefey SA, et al. CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts . Am J Radio! . 1990;154:79-85. 26. Lam SK, Wong KP, Chan PKW, Ngan H, Ong GB. Recurrent pyogenic cholangitis: a study by endoscopie retrograde cholangiography . Gastroenterology . 1978;74:1196-1203. 27. Stain SC, Yellin AE, Donovan AJ, Brien HW. Pyogenic liver abscess: modern treatment . Arch Surg . 1991;126:991-996.Crossref 28. Trambert JJ, Bron KM, Zakjo AB, Starzl TE, Iwatsuki S. Percutaneous transhepatic balloon dilation of benign biliary strictures . AJR Am J Roentgneol . 1987; 149:945-948.Crossref 29. Sauerbuch T. Non-surgical management of bile duct stones refractory to routine endoscopie measures . Clin Gastroenterol . 1992;6:799-817. 30. Pitt HA, Venbrux AC, Coleman J, et al. Intrahepatic stones: the transhepatic team approach . Ann Surg . 1994;219:527-537.Crossref 31. Fang D, Chou TC. Subcutaneous blind loop: a new type of hepaticocholedochojejunostomy for bilateral intrahepatic calculi . Chin Med J . 1977;3:413-418. 32. Hutson DG, Russell E, Schiff E, Levi JJ, Jeffers L, Zeppa R. Balloon dilatation of biliary strictures through a choledochojeiunocutaneous fistula . Ann Surg . 1984;199:637-647.Crossref 33. Fan ST, Mok F, Zheng SS, Lai ECS, Lo CM, Wong J. Appraisal of hepaticocutaneous jejunostomy in the management of hepatolithiasis . Am J Surg . 1993; 165:332-335.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430050077013
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Abstract

Abstract Objective: To examine the evolving operative strategies in the treatment of recurrent pyogenic cholangitis (RPC). Design: Case series of patients with RPC treated surgically at the Los Angeles County-University of Southern California Medical Center between 1980 and 1994. Setting: Public teaching hospital. Patients: Twenty patients with RPC were studied. The clinical diagnosis of RPC was made in patients with a syndrome of chronic intermittent attacks of biliary sepsis associated with intrahepatic biliary strictures and intrahepatic stones. Main Outcome Measure: The need for repeated biliary intervention after surgical treatment of RPC. Results: Four patients had a hepatic lobectomy without biliary enteric bypass. One patient had an uneventful course. Three patients had postoperative biliary sepsis, and one of these patients died. A hepaticojejunostomy without a cutaneous stoma was performed in eight patients. Five (63%) of these eight required repeated operation for biliary sepsis 1 to 4 years after surgery. In eight patients, a Rouxen-Y hepaticojejunostomy was performed after attempted clearance of intrahepatic stones with construction of a temporary cutaneous stoma. Postoperatively, these eight patients had 16 transstomal endoscopic cholangiograms (mean follow-up, 10 months). Stones proximal to intrahepatic strictures were identified in seven endoscopic sessions in five of these patients (63%). The stones were removed, and the strictures were endoscopically dilated. None required repeated biliary operation. Conclusion: RPC is a progressive, lifelong disease. Construction of a hepaticojejunostomy with a cutaneous stoma allows future therapeutic intervention without the need for repeated surgery.(Arch Surg. 1995;130:527-533) References 1. Wen CC, Lee HC. Intrahepatic stones: a clinical study . Ann Surg . 1972;175: 166-177.Crossref 2. Carmona RH, Crass RA, Lim RC, Trunkey DD. Oriental cholangitis . Am J Surg . 1984;148:117-124.Crossref 3. Turner WW, Cramer CR. Recurrent Oriental cholangiohepatitis . Surgery . 1983; 93:397-401. 4. Yellin AE, Donovan AJ. Biliary lithiasis and helminthiasis . Am J Surg . 1981; 142:128-136.Crossref 5. Chang TM, Passaro EM. Intrahepatic stones: the Taiwan experience . Am J Surg . 1983;146:241-244.Crossref 6. Choi TK, Wong J. Partial hepatectomy for intrahepatic stones . World J Surg . 1986;10:281-286.Crossref 7. Ong GB. A study of recurrent pyogenic cholangitis . Arch Surg . 1962;84:63-89.Crossref 8. Choi TK, Wong, Ong GB. The surgical management of primary intrahepatic stones . Br J Surg . 1982;69:86-90.Crossref 9. Digby KH. Common duct stones of liver origin . Br J Surg . 1930;17:578-591.Crossref 10. Cobo A, Hall RC, Torres E, Cuello CJ. Intrahepatic calculi . Arch Surg . 1964; 89:936-941.Crossref 11. Simi M, Loriga P, Basoli A, Leardi S, Speranza V. Intrahepatic lithiasis: a study of 36 cases and review of the literature . Am J Surg. 1979;137:317-322.Crossref 12. Shulman A. Non-Western patterns of biliary stones and the role of ascariasis . Radiology . 1987;162:425-430.Crossref 13. Fung J. Liver fluke infestation and cholangio-hepatitis . Br J Surg . 1961;48: 404-415.Crossref 14. Seel Park YY. Oriental infestainal cholangitis . 370. 15. Chou ST, Chan CW. Recurrent pyogenic cholangitis: a necropsy study . Pathology . 1980;12:415-428.Crossref 16. Choi TK. Intrahepatic stones . BrJSurg . 1989;76:213-214. 17. Lim JH, Ko YT, Lee DH, Hong KS, Oriental cholangiohepatitis: sonographic findings in 48 cases . AJR Am J Roentgenol . 1990;155:511-514.Crossref 18. Wong J, Choi TK. Recurrent pyogenic cholangitis . In: Blumgart LH, ed. Surgery of the Liver and Biliary Tract Edinburgh, Scotland: Churchill Livingstone; 1988:977-992. 19. Rails PW, Colletti PM, Quinn MF, Lapin SA, Morris UL, Halls JM. Sonography in recurrent pyogenic cholangitis . AJR Am J Roentgenol . 1981;136:10101012. 20. Feeny PC. Acute pyogenic hepatitis: sonographic and angiographie findings . AJR Am J Roentgenol . 1980;135:388-391.Crossref 21. Chau EMT, Leong LLY, Chan FL. Recurrent pyogenic cholangitis: ultrasound evaluation compared with endoscopie retrograde cholangiopancreatography . Clin Radio! . 1987;35:79-85.Crossref 22. Chan FK, Man SW, Leong LLY, Fan ST. Evaluation of recurrent pyogenic cholangitis: CT analysis of 50 patients . Radiology . 1989;170:165-169.Crossref 23. van Sonnenburg E, Casóla G, Cubberly DA, et al. Oriental cholangiohepatitis: diagnostic imaging and interventional management . AJR Am J Roentgenol . 1986; 146:327-331.Crossref 24. Fan ST, Lai ECS, Wong J. Hepatic resection for hepatolithiasis . Arch Surg . 1993;128:1070-1074.Crossref 25. Shulte SJ, Baron RL, Teefey SA, et al. CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts . Am J Radio! . 1990;154:79-85. 26. Lam SK, Wong KP, Chan PKW, Ngan H, Ong GB. Recurrent pyogenic cholangitis: a study by endoscopie retrograde cholangiography . Gastroenterology . 1978;74:1196-1203. 27. Stain SC, Yellin AE, Donovan AJ, Brien HW. Pyogenic liver abscess: modern treatment . Arch Surg . 1991;126:991-996.Crossref 28. Trambert JJ, Bron KM, Zakjo AB, Starzl TE, Iwatsuki S. Percutaneous transhepatic balloon dilation of benign biliary strictures . AJR Am J Roentgneol . 1987; 149:945-948.Crossref 29. Sauerbuch T. Non-surgical management of bile duct stones refractory to routine endoscopie measures . Clin Gastroenterol . 1992;6:799-817. 30. Pitt HA, Venbrux AC, Coleman J, et al. Intrahepatic stones: the transhepatic team approach . Ann Surg . 1994;219:527-537.Crossref 31. Fang D, Chou TC. Subcutaneous blind loop: a new type of hepaticocholedochojejunostomy for bilateral intrahepatic calculi . Chin Med J . 1977;3:413-418. 32. Hutson DG, Russell E, Schiff E, Levi JJ, Jeffers L, Zeppa R. Balloon dilatation of biliary strictures through a choledochojeiunocutaneous fistula . Ann Surg . 1984;199:637-647.Crossref 33. Fan ST, Mok F, Zheng SS, Lai ECS, Lo CM, Wong J. Appraisal of hepaticocutaneous jejunostomy in the management of hepatolithiasis . Am J Surg . 1993; 165:332-335.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1995

References