Clinical evaluation and treatment in elderly patients with acute obstructive suppurative cholangitis

Higashiguchi, Takashi; Kawarada, Yoshifumi; Yokoi, Hiroyoshi; Ito, Akihiro; Ido, Masayoshi

doi:10.1007/bf01212775

Cited by 3 publications

(1 citation statement)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study of 21 patients with suppurative cholangitis ranging from 49 to 81 years of age (mean age, 64.7 years), Charcot triad was observed in 85% of patients. 8 Elderly patients (defined as >70 years of age) were significantly more likely to present with disturbances of consciousness and Reynolds pentad than younger patients (defined as <70 years of age). In a smaller study of 17 patients with cholangitis only, 4 patients (23.5%) presented with Charcot triad while only 1 patient presented with the complete pentad.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Charcot Triad, Reynolds Pentad, and Tokyo Guidelines for Diagnosis of Cholangitis Secondary to Choledocholithiasis Across Patient Age Groups

Thuluvath

Ahn

Rattan

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

View full text Add to dashboard Cite

Objective: To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups. Patients and Methods: We conducted a retrospective analysis of 257 consecutive hospitalized adult patients with acute cholangitis due to endoscopic retrograde cholangiopancreatographyeconfirmed choledocholithiasis between January 1, 2015, and December 31, 2019. Patients were divided into 3 age groups: less than 65 years, 65 to 79 years, and 80 years or older. Symptoms, vital signs, and laboratory data on admission were collected. Outcomes included length of hospitalization, intensive care unit stay, and 3-month mortality. Nominal variables were tested with the Pearson c 2 test, and continuous variables were tested with the Wilcoxon rank sum test. Results: Charcot triad decreased with older ages. In the group that was age 80 years or older, malaise was the most common symptom; 33.6% (37 of 110) presented with altered sensorium, 9.1% (10 of 110) had no pain, fever, or jaundice, and positive blood culture results were more frequent. Tokyo cholestasis criterion was present in 96.0% (247 of 257), while inflammation (considered essential for diagnosis) was present in 75.9% (195 of 257). Patients 80 years or older had significantly higher mean length of hospital stay (P<.001) and mean length of intensive care unit stay (P¼.021). Conclusion: Compared with patients in younger age groups, patients with cholangitis who are 80 years or older are less likely to have Charcot triad, are more likely to have features of Reynolds pentad, or present with unexplained malaise. Within the Tokyo Guidelines, cholestasis should replace inflammation as an essential diagnostic criterion.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of Charcot Triad, Reynolds Pentad, and Tokyo Guidelines for Diagnosis of Cholangitis Secondary to Choledocholithiasis Across Patient Age Groups

Thuluvath

Ahn

Rattan

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

View full text Add to dashboard Cite

show abstract

Endotoxin adsorption therapy using polymyxin B-immobilized fiber as a treatment for septic shock-associated severe acute cholangitis

Inoué

Fujino

Onodera

et al. 2013

Clin J Gastroenterol

View full text Add to dashboard Cite

The application of endotoxin adsorption therapy for severe acute cholangitis is controversial. We present a survival case of septic shock and multiple organ failure due to severe acute cholangitis. The patient was treated by endotoxin adsorption therapy using polymyxin B-immobilized fiber because he continued to remain in shock even after successful endoscopic nasobiliary drainage. The patient was an 84-year-old male diagnosed with acute cholangitis and acute pancreatitis who was transferred to our department because of shock and severe dyspnea. The patient had already developed acute respiratory failure, acute renal failure, and disseminated intravascular coagulation. We performed endoscopic nasobiliary drainage immediately, but the patient continued to remain in shock and plasma endotoxin level was markedly elevated at 133.6 pg/mL. Therefore, we performed direct hemoperfusion with polymyxin B-immobilized fiber. On starting the hemoperfusion, blood pressure and urine volume increased, and the plasma endotoxin level reduced considerably. On the basis of our experience in this case, we think that direct hemoperfusion with polymyxin B-immobilized fiber may be a useful modality in the management of severe acute cholangitis.

show abstract

Erratum to: Endotoxin adsorption therapy using polymyxin B-immobilized fiber as a treatment for septic shock-associated severe acute cholangitis

Inoué

Fujino

Onodera

et al. 2013

Clin J Gastroenterol

View full text Add to dashboard Cite

Clinical evaluation and treatment in elderly patients with acute obstructive suppurative cholangitis

Cited by 3 publications

References 6 publications

Evaluation of Charcot Triad, Reynolds Pentad, and Tokyo Guidelines for Diagnosis of Cholangitis Secondary to Choledocholithiasis Across Patient Age Groups

Evaluation of Charcot Triad, Reynolds Pentad, and Tokyo Guidelines for Diagnosis of Cholangitis Secondary to Choledocholithiasis Across Patient Age Groups

Endotoxin adsorption therapy using polymyxin B-immobilized fiber as a treatment for septic shock-associated severe acute cholangitis

Erratum to: Endotoxin adsorption therapy using polymyxin B-immobilized fiber as a treatment for septic shock-associated severe acute cholangitis

Contact Info

Product

Resources

About