Advertisement

Commentary: Recurrent Pyogenic Cholangitis

  • Henry A. PittEmail author

Abstract

“Recurrent Pyogenic Cholangitis” (RPC) is a term that describes an advanced disease with intrahepatic stones and pus in the biliary tree. RPC occurs most frequently in Southeast Asia in patients of lower socioeconomic class who may have hepatic parasites and/or intrahepatic congenital biliary cysts. Up to two-thirds of Western patients with hepatolithiasis will present with cholangitis, and magnetic resonance imaging is recommended to establish a diagnosis. Management of cholangitis is standard with the exception that patients with recurrent episodes frequently will have resistant organisms and/or yeast. For isolated, especially left-sided, disease, lateral sectionectomy or left hepatectomy is recommended. However, the majority of patients will have bilateral disease without advanced fibrosis so liver transplantation is rarely indicated. In patients with bilateral hepatolithiasis, endoscopic management usually is not successful, but many of these patients can be treated by interventional radiologists (IR). When the stone burden is great, a combined IR and surgical (transhepatic team) approach is recommended. Intraoperative and postoperative choledochoscopy are key to this approach along with large-bore transhepatic stents which exit the liver and extend into a Roux-en-Y hepaticojejunostomy. With this “team approach” 90 % of patients remain symptom free without evidence of stone recurrence.

Keywords

Cholangiocarcinoma Cholangitis Choledochoscopy Hepatectomy Hepaticojejunostomy Hepatolithiasis Intrahepatic stones Lithotripsy 

References

  1. 1.
    Jo JH, Chung MJ, Park JY, Bang S, Park SW, Lee WJ, et al. High serum CA 19-9 levels are associated with an increased risk of cholangiocarcinoma in patients with intrahepatic duct stones: a case-control study. Surg Endosc. 2013;27:4210–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Suzuki Y, Mori T, Yokoyama M, Nakazato T, Abe N, Tsubouchi H, et al. Hepatolithiasis: analysis of Japanese nationwide surveys over a period of 40 years. J Hepatobiliary Pancreat Sci. 2014;21:617–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Pitt HA, Venbrux AC, Coleman J, Presscott CA, Johnson MS, Osterman Jr FA, et al. Intrahepatic stones: the transhepatic team approach. Ann Surg. 1994;219:527–37.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Li SQ, Liang LJ, Peng BJ, Hua YP, Lv MD, Fu SJ, et al. Outcomes of liver resection for intrahepatic stones: a comparative study of unilateral versus bilateral disease. Ann Surg. 2012;255:946–53.PubMedCrossRefGoogle Scholar
  5. 5.
    Lin CC, Lin PY, Ko CJ, Chen YL, Chen ST, Kuo SJ. Hepatic reaction for bilateral hepatolithiasis: a 20-year experience. ANZ J Surg. 2013;83:978–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Temple University School of MedicinePhiladelphiaUSA
  2. 2.Temple University Health SystemPhiladelphiaUSA

Personalised recommendations