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

Abstract

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.

Endoscopic Biliary Drainage by 7 Fr or 10 Fr Stent Placement in Patients with Acute Cholangitis

“…When the cholangitis improves, patients can undergo endoscopic sphincterotomy with stone extraction. Ikeda et al [24] reported three patients with suppurative cholangitis who were successfully treated by duodenoscopic cannulation with disimpaction of stones. Lin et al [13] reported a 100% success rate and no mortality with nasobiliary drainage in 40 patients with acute cholangitis.…”

Problems Inherent to Balloon Dilation for the Treatment of Common Bile Duct Stones in Comparison With Endoscopic Sphincterotomy

“…22 Major bleeding can be managed by endoscopic hemostasis or surgery. Among a variety of early complications associated with ES and EPBD, acute cholangitis can now be either prevented by stenting 13 or treated by endoscopic biliary drainage.…”

“…Among a variety of early complications associated with ES and EPBD, acute cholangitis can now be either prevented by stenting 13 or treated by endoscopic biliary drainage. 22 Major bleeding can be managed by endoscopic hemostasis or surgery. Perforation can be treated by surgical intervention when it does not improve by conservative therapy.…”

Definition of acute obstructive suppurative cholangitis

“…Percutaneous transhepatic and transendoscopic transpapillary biliary drainage have been used successfully in selected cases to provide urgent decompression prior to removal of the obstructing stone . The dramatic improvement in outcome by decompression alone confirmed the critical role that elevated biliary pressure played in the toxic manifestations of the illness.…”