Abstract
Bacterial reflux from the biliary tract to the systemic circulation is considered to be the primary etiologic factor in bacteremia and the development of sepsis. However, as the pathophysiologic features of the biliary tract that may promote such a reflux of biliary bacteria remain unclear, we investigated, using direct cholangiography, the pathophysiologic relationship between the intrahepatic bile ducts and biliary reflux into the systemic circulation after the percutaneous infusion of a contrast material containing indocyanine green (ICG) into the circulating blood. The subjects were 19 patients who underwent percutaneous transhepatic cholangiography with drainage to treat either a biliary infection or obstructive jaundice, an 8 post-T-tube control patients with normal biliary drainage. The relationship between the biliary tract pressure and ICG reflux during cholangiography was also analyzed. An ICG reflux was observed in all 19 patients who had undergone percutaneous transhepatic cholangiography with drainage and in 2 of the 8 control patients. In all patients who showed positive ICG reflux, this occurred when the biliary pressure increased to 25cm H2O. An ICG reflux was seen in the 16 patients with a positive bile culture, and in 7 of 13 patients with a negative bile culture. When we analyzed ICG reflux in relation to the morphology of the intrahepatic bile duct, we found that all 4 patients who had cholangitic hepatic abscesses also exhibited higher ICG reflux concentrations and the clinical symptoms of cholangitis. Radiologically, all 7 patients with cholangitis demonstrated many small intrahepatic branches, and they exhibited moderate ICG refluxes, whereas the 6 patients who had obstructive jaundice but no cholangitis had fewer ICG refluxes and no clinical symptoms. This study demonstrated two possible pathophysiological routes for biliary reflux: (1) via cholangitic hepatic abscesses, with entry of the bacteria directly into the circulating blood, or (2) via the small intrahepatic biliary branches, in which entry of bacteria into the systemic circulation occurs through the cholangioles.
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References
Longmire WP (1971) Cholangitis. In: Hardy WP (ed) Critical surgical illness. WB Saunders, Philadelphia, U.S.A. p 397
Reynolds BM, Dargan EL (1959) Acute obstructive cholangitis. A distinct clinical syndrome. Ann Surg 150:299–303
Glenn F, Moody FG (1961) Acute obstructive suppurative cholangitis. S.G.O. 113:265–273
Mixer HW, Riger LG, Oddone MVG (1974) Experimental studies on biliary regurgitation during cholangiography. Gastroenterology 9:64–80
Huang T, Bass JA, Williams RD (1969) The significance of biliary pressure in cholangitis. Arch Surg 98:629–632
Jacobsson B, Kjellander J, Rosengren B (1962) Cholangiovenous reflux. An experimental study. Acta Chir Scand 123:316–321
Hultborn A, Jacobsson B, Rosengren B (1962) Cholangiovenous reflux during cholangiography — an experimental and clinical study. Acta Chir Scand 123:111–117
Lygidakis NJ, Brummelkamp WH (1986) The significance of intrabiliary pressure in acute cholangitis. S.G.O. 161:465–469
Takada T, Hanyu F, Mikoshiba Y, Nakayama K, (1974) Severe choledochocholangitis causing numerous cyst-like hepatic abscesses. Int Surg 59:180–182
Kune GA, Sali A (1980) The practice of biliary surgery. Blackwell Scientific, Oxford
Kune GA, Hibberd J, Moahan R (1974) The development of biliary infection. An experimental study, Med J Aust 1:301–305
Flemma RJ, Flint LM, Osterhout S (1967) Bacteriologic studies of biliary tract infections. Ann Surg 166:563–572
Takada T, Hanyu F, Kobayashi S, Uchida Y (1976) Percutaneous transhepatic cholangial drainage: Direct approach under fluoroscopic control. J Surg Oncol 8:83–97
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Takada, T., Yasuda, H. & Hanyu, F. Pathophysiologic mechanisms in patients with cholangitis or obstructive jaundice: Results of a cholangiographic study. J Hep Bil Pancr Surg 3, 17–22 (1996). https://doi.org/10.1007/BF01212774
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DOI: https://doi.org/10.1007/BF01212774