Recurrent Pyogenic Cholangitis

Recurrent pyogenic cholangitis is a condition that most commonly affects patients of East Asian descent. It is characterized by recurrent bouts of cholangitis. Work-up with ultrasound, computed tomography, and more specifically magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP), reveals areas of biliary dilatation and stricturing, most commonly affecting the left hepatic ducts. Initial treatment includes supportive medical therapy with intravenous fluids and electrolytes, correction of coagulopathy if present, and antibiotics. Once stabilized, patients should receive urgent biliary decompression. This may be achieved using ERCP or percutaneous transhepatic cholangiogram (PTC). ERCP is excellent at decompressing more distal obstruction, whereas PTC provides reliable drainage of peripherally obstructed bile ducts. If disease is anatomically limited, surgical resection with excision of the extrahepatic bile ducts and involved intrahepatic segments (usually left lobe) should be performed. Otherwise, repeated radiographic and endoscopic procedures will be necessary to treat recurrent cholangitis. Liver transplant may be an option for patients with diffuse disease.