Acute Suppurative Cholangitis

Haupert, Alexander; Carey, Larry C.; Evans, William E.; Ellison, Edwin H.

doi:10.1001/archsurg.1967.01330100024004

Cited by 44 publications

(7 citation statements)

References 4 publications

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“…They also developed the current clinical concept of acute obstructive suppurative cholangitis. Since then, however, cases of disease with the same characteristics have been variously termed acute obstructive cholangitis, acute suppurative cholangitis [2,3], and acute obstructive suppurative cholangitis [4,5], and the definition of these terms has become somewhat confused. In particular, the term ASC, much used nowadays, is used to include an ever-broader range of disease, far more than the original clinical conception defined by Reynolds.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, the principles of treatment of acute obstructive cholangitis have emphasized early surgical decompression drainage of the obstructed and infected bile duct and at that time antibiotic treatment, together with correction of hypovolemic shock and prevention and treatment of oliguric renal failure. These cardinal principles of management still apply in 1984, but recent work by Bismuth and co-workers in 1975 [2] and Faber and coworkers in 1978 [3] indicates that the correction of hypovolemic shock, antibiotic use, and the management of renal failure, in most cases, receive first priority before surgery, even though bile duct de-…”

Section: Discussionmentioning

confidence: 99%

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Cholangitis

et al. 1984

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Comparative study of the clinical features of 125 cases of acute cholangitis revealed that acute obstructive suppurative cholangitis (AOSC, 19 cases) was characterized by leukocytosis, high transaminase levels, bilirubinemia, and a marked thrombocytopenia. Most species of bacilli isolated from the purulent bile were gram‐negative and in 9 of 12 cases of AOSC that we checked, the same species were found in the blood as in the bile. In 12 of the 19 cases of AOSC, plasma endotoxin levels were assayed by theLimulus test and found to be elevated. Of the 22 cases of cholangitis other than AOSC, only 5 showed transitory positive results. Laparotomy decompression of the bile duct in 8 patients with AOSC resulted in 4 deaths from post‐operative complications. However, 7 of the 11 patients placed on emergency percutaneous transhepatic cholangio‐drainage (PTCD) recovered from shock and underwent successful surgery later. We confirmed in an experimental study the initiation of cholangiovenous reflux in mongrel dogs. The cholangiovenous reflux of bacteria or endotoxin seems to induce the state of shock in patients with AOSC. In conclusion, we recommend that emergency decompression of the biliary tract even for AOSC patients in shock be performed by a procedure less risky than laparotomy, such as PTCD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cholangitis

et al. 1984

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“…The appearance of lethargy warns of a succession of other central nervous system symptoms, such as disorientation, confusion, stupor, and coma, not infrequently leading to shock and death within hours [10,15]. Medical treatment alone carries a virtually 100% mortality in patients with these ominous signs [6,11,13,15]. Direct drainage of the common duct has been advocated because of its efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Although no single investigator accumulated a large number of patients, the uniform experience of 100% mortality in nonoperated cases has been described in all previous articles. Furthermore, even emergency exploration still carries a high mortality, variously reported as 33% [6] or 41% [12]. The need for early surgical decompression and drainage of the common duct even in moribund patients has been repeatedly emphasized [4][5][6][10][11][12][13][14][15][16].…”

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Emergency decompression of bile duct in acute obstructive suppurative 3 cholangitis by duodenoscopic cannulation: A lifesaving procedure

et al. 1981

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Acute obstructive suppurative cholangitis is a life-threatening condition characterized by abdominal pain, jaundice, spiking fever, shock, and central nervous system depression. Biliary calculi are by far the most common obstructing mechanism. This entity carries an almost 100 % mortality unless early decompression of the obstructed common bile duct is performed. With recent progress in duodenofiberscopy, this can be accomplished by endoscopic cannulation using a large-calibre stiff catheter. Three consecutive patients recently treated in the Kyushu University Hospital are presented. All were female and a stone was the cause of the obstruction in all. The stones impacted at the distal common bile duct of these patients were dislodged by endoscopic cannulation, resulting in a release of purulent bile and a dramatic improvement in the symptoms and signs. Endoscopic decompression is a quick, safe, and effective procedure for emergency treatment of acute obstructive suppurative cholangitis.

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