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Ultrasonic Guided Percutaneous Transhepatic Bile Drainage for Cholangitis due to Intrahepatic Stones

Ultrasonic Guided Percutaneous Transhepatic Bile Drainage for Cholangitis due to Intrahepatic Stones Abstract • Acute cholangitis due to intrahepatic stones is frequently associated with biliary sepsis. Emergency surgery for these high-risk patients is usually associated with a high mortality. Therefore, we recommend nonoperative methods for the management of this acute disease. Percutaneous transhepatic cholangiography and drainage (PTCD) combined with antibiotic and fluid treatment was used successfully in the management of 41 patients with acute pyogenic cholangitis due to intrahepatic stones. The general condition of these patients improved after treatment with PTCD. Repeated cholangiography should be performed so that the entire biliary tree and lesions can be viewed. Elective surgery (21 patients) or removal of the stone through the sinus tract via PTCD (14 patients) was performed when the patients' general condition improved following emergency PTCD. Therefore, we recommend PTCD over emergency surgery in the treatment of acute septic intrahepatic stones. (Arch Surg 1988;123:106-109) References 1. Wen CC, Lee HC: Intrahepatic stones: A clinical study . Ann Surg 1972;175:166-177.Crossref 2. Ker CG, Huang TJ, Sheen PC: Intrahepatic stones: I. Etiological study . J Formosan Med Assoc 1981;80:698-711. 3. Nakayama F, Koga A: Hepatolithiasis: Present status . World J Surg 1984;8:9-14.Crossref 4. Makuuchi M, Bendai Y, Ito T: Ultrasonically guided percutaneous transhepatic bile drainage . Radiology 1980;136:165-169.Crossref 5. Chen MF, Wang CS, Chou FF, et al: A clinical analysis of fulminating acute cholangitis . J Formosan Med Assoc 1982;81:745-751. 6. Wei TC, Hsu SC: Transduodenal sphincteroplasty in the treatment of intrahepatic stones . J Surg Assoc ROC 1976;9:1-16. 7. Seel DJ, Park YK: Oriental infestation cholangitis . Am J Surg 1983;146:366-370.Crossref 8. Thompson JE, Tompkins RK, Longmire WP: Factors in management of acute cholangitis . Ann Surg 1982;195:137-145.Crossref 9. Ong GB: A study of recurrent pyogenic cholangitis . Arch Surg 1962;84:199-225.Crossref 10. Harrison-Levy A: The biliary obstructive syndrome of the Chinese . Br J Surg 1962;49:674-685.Crossref 11. Takada T, Kobayashi M, Yamada A: A new technique for the diagnosis and therapy of cholangitic hepatic abscess: Percutaneous transhepatic cholangial drainage . Jpn J Gastroenterol 1974;71:657-665. 12. Dow RW, Lindenauer SM: Acute obstructive suppurative cholangitis . Ann Surg 1969;169:272-276.Crossref 13. Pitt HA, Longmire WP Jr: Suppurative cholangitis , in Hardy JD (ed): Critical Surgical Illness . Philadelphia, WB Saunders Co, 1980, pp 380-408. 14. Boey JH, Way LW: Acute cholangitis . Ann Surg 1980;191:264-270.Crossref 15. Chock EC, Wolfe BM, Matole NM: Acute suppurative cholangitis . Surg Clin North Am 1981;61:885-892. 16. Grossman RI, Ring EJ, Oleaga JA, et al: Diagnosis of pyogenic hepatic abscesses by percutaneous transhepatic cholangiography . AJR 1979;132: 919-920.Crossref 17. Nunez D, Guerra JJ, Al-Sheikh WA, et al: Percutaneous biliary drainage in acute suppurative cholangitis . Gastrointest Radiol 1986;11:85-89.Crossref 18. Welch JP, Donaldson GA: The urgency of diagnosis and surgical treatment of acute suppurative cholangitis . Am J Surg 1976;131:527-532.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Ultrasonic Guided Percutaneous Transhepatic Bile Drainage for Cholangitis due to Intrahepatic Stones

Archives of Surgery , Volume 123 (1) – Jan 1, 1988

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400250116023
Publisher site
See Article on Publisher Site

Abstract

Abstract • Acute cholangitis due to intrahepatic stones is frequently associated with biliary sepsis. Emergency surgery for these high-risk patients is usually associated with a high mortality. Therefore, we recommend nonoperative methods for the management of this acute disease. Percutaneous transhepatic cholangiography and drainage (PTCD) combined with antibiotic and fluid treatment was used successfully in the management of 41 patients with acute pyogenic cholangitis due to intrahepatic stones. The general condition of these patients improved after treatment with PTCD. Repeated cholangiography should be performed so that the entire biliary tree and lesions can be viewed. Elective surgery (21 patients) or removal of the stone through the sinus tract via PTCD (14 patients) was performed when the patients' general condition improved following emergency PTCD. Therefore, we recommend PTCD over emergency surgery in the treatment of acute septic intrahepatic stones. (Arch Surg 1988;123:106-109) References 1. Wen CC, Lee HC: Intrahepatic stones: A clinical study . Ann Surg 1972;175:166-177.Crossref 2. Ker CG, Huang TJ, Sheen PC: Intrahepatic stones: I. Etiological study . J Formosan Med Assoc 1981;80:698-711. 3. Nakayama F, Koga A: Hepatolithiasis: Present status . World J Surg 1984;8:9-14.Crossref 4. Makuuchi M, Bendai Y, Ito T: Ultrasonically guided percutaneous transhepatic bile drainage . Radiology 1980;136:165-169.Crossref 5. Chen MF, Wang CS, Chou FF, et al: A clinical analysis of fulminating acute cholangitis . J Formosan Med Assoc 1982;81:745-751. 6. Wei TC, Hsu SC: Transduodenal sphincteroplasty in the treatment of intrahepatic stones . J Surg Assoc ROC 1976;9:1-16. 7. Seel DJ, Park YK: Oriental infestation cholangitis . Am J Surg 1983;146:366-370.Crossref 8. Thompson JE, Tompkins RK, Longmire WP: Factors in management of acute cholangitis . Ann Surg 1982;195:137-145.Crossref 9. Ong GB: A study of recurrent pyogenic cholangitis . Arch Surg 1962;84:199-225.Crossref 10. Harrison-Levy A: The biliary obstructive syndrome of the Chinese . Br J Surg 1962;49:674-685.Crossref 11. Takada T, Kobayashi M, Yamada A: A new technique for the diagnosis and therapy of cholangitic hepatic abscess: Percutaneous transhepatic cholangial drainage . Jpn J Gastroenterol 1974;71:657-665. 12. Dow RW, Lindenauer SM: Acute obstructive suppurative cholangitis . Ann Surg 1969;169:272-276.Crossref 13. Pitt HA, Longmire WP Jr: Suppurative cholangitis , in Hardy JD (ed): Critical Surgical Illness . Philadelphia, WB Saunders Co, 1980, pp 380-408. 14. Boey JH, Way LW: Acute cholangitis . Ann Surg 1980;191:264-270.Crossref 15. Chock EC, Wolfe BM, Matole NM: Acute suppurative cholangitis . Surg Clin North Am 1981;61:885-892. 16. Grossman RI, Ring EJ, Oleaga JA, et al: Diagnosis of pyogenic hepatic abscesses by percutaneous transhepatic cholangiography . AJR 1979;132: 919-920.Crossref 17. Nunez D, Guerra JJ, Al-Sheikh WA, et al: Percutaneous biliary drainage in acute suppurative cholangitis . Gastrointest Radiol 1986;11:85-89.Crossref 18. Welch JP, Donaldson GA: The urgency of diagnosis and surgical treatment of acute suppurative cholangitis . Am J Surg 1976;131:527-532.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1988

References