Oriental infestational cholangitis

Biliary ascariasis in the etiology of recurrent pyogenic cholangitis in an endemic area

“…The popular theory that portal bacteraemia causing portal phlebitis secondarily spreads to the ductal system is fraught with major criticism. The infection having reached into the liver is excreted into the bile and it is generally agreed that no serious consequences would ensue as long as there is free biliary drainage [4]. Bockus considers that portal bacteraemia is harmless under ordinary circumstances [29] and Wilkis also believes that bacteria excreted into the bile will not usually give rise to infection [30].…”

“…The disease has also been reported from Indonesia, Japan, Singapore, Malaysia, South Africa and Chinese Immigrants in Canada [2][3][4][5][6][7][8][9]. In India (Kashmir), RPC constitutes 12.5% of all patients with biliary disease [10].…”

“…The popular hypothesis include: a) portal bacteraemia leading to portal phlebitis which secondarily spreads to ductal system [15]; (b) invasion of bile ducts by parasites, viz. Ascaris lumbricoides and Clonorchis sinensis, which carry enteric organisms along with into the bile ducts [4,11,17,18]. Ascaris lumbricoides is highly endemic and Clonorchis sinensis infection is not known to occur in Kashmir, India.…”

Biliary Infections

“…The high rate of infestation with biliary parasites such as Clonorchis sinensis and Ascaris lumbricoides found in some series suggests that these parasites induce ductal injury and stricture formation by evoking an exuberant inflammatory response and that secondary pyogenic infection leads to stone formation and recurrent cholangitis [78,79]. However, parasites are recovered from stool specimens in only 5-25 % of patients with recurrent pyogenic cholangitis [80].…”

Plattenepithelkarzinom der Leber

“…Warum es zu einer biliären Infektion auf hämatogenem Weg kommen kann, ist nicht eindeutig geklärt. Ein Wurmbefall (Clonorchis sinensis,Ascaris lumbricoides), der in Asien teilweise endemisch ist, könnte Gallengangsverletzungen mit konsekutiven Strikturen verursachen und über eine bakterielle Superinfektion mit Steinbildung zu rezidivierenden Cholangitiden führen [23].…”