Résumé
Toute infection des voies biliaires se doit ďêtre traitee rapidement, à la fois par un drainage suffisant et une antibiothérapie adéquate.
Nous avons étudié rétrospectivement ľévolution de 40 patients, admis à ľhôpital pour angiocholite aiguë lithiasique. Ils constituent 16 % des malades hospitalisés pour lithiase biliaire. Ils ont béneficié dans le même temps ďune cholangio-pancréatographie endoscopique diagnostique et ďune sphinctérotomie, suivie de ľextraction partielle ou totale de calculs de la voie bilaire principale. Dans tous les cas, un drainage suffisant des voies biliaires a été obtenu. Dans 92 % des cas, la décompression de ľarbre biliaire a permis une amélioration clinique rapide et un retour de la bilirubine à des valeurs normales dans les 5 jours. La morbidité liée à ľacte endoscopique est de 12 % ; aucune complication n’a imposé de chirugie. La mortalité est nulle. Dans 84 % des cas, il existait associée aux calculs biliaires une lithiase vésiculaire. Les patients âgés (âge moyen : 80 ans) sans signe de cholécystite aiguä - soit 16 malades - ne furent pas cholécystectomisés.
Ľefficacité et la relative innocuité de la sphinctérotomie endoscopique justifient une approche endoscopique immédiate quand la clinique suggére une angiocholite lithiasique.
Summary
A biliary infection has to be managed immediately, with sufficient drainage and adequate antibiotherapy.
We looked retrospectively after 40 patients, admitted for acute cholangitis attributed to biliary stones. They represent 16 % of inpatients suffering from choledocolithiasis. An ERCP followed by a sphincterotomy was performed in all cases, with partial or total extraction of biliary calculi. A sufficient drainage was always achieved. In 92 % of the cases, biliary decompression allowed an immediate clinical improvement with a fall to normal of the bilirubin levels within 5 days. Endoscopy-related morbidity was 12 % ; no complication led to surgery. There is no mortality.
In 84 % of the cases, gallbladder stones were associated with choledoco-lithiasis. Old people (mean age : 80) without signs of acute cholecystitis — 16 patients — did not undergo cholecystectomy.
Immediate endoscopic management is efficient and rather innocuous ; it is proposed as first attempt in case of acute cholangitis.
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Bourgeois, N., Jeanmart, J., Costamagna, G. et al. L’angiocholite aiguë: Une indication particulière de ľendoscopie agressive précoce. Acta Endosc 16, 195–203 (1986). https://doi.org/10.1007/BF02962916
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DOI: https://doi.org/10.1007/BF02962916