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Acute cholangitis.

P A Lipsett1, H A Pitt

  • 1Department of Surgery, Johns Hopkins University, Baltimore, Maryland.

The Surgical Clinics of North America
|December 1, 1990
PubMed
Summary
This summary is machine-generated.

Cholangitis, a biliary duct infection, is increasingly caused by medical procedures, not just gallstones. While classic symptoms are less common, prompt antibiotic treatment and, if needed, biliary decompression are key to recovery.

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Medical Procedures

Background:

  • Cholangitis is an infection of the biliary ductal system, often stemming from bacterial presence and biliary obstruction.
  • Historically, choledocholithiasis (gallstones) was the primary cause, but nonoperative biliary manipulations, particularly in patients with unresectable malignancies, are now more common etiologies, especially in tertiary care settings.
  • The classic Charcot's triad (fever, jaundice, abdominal pain) is observed less frequently, with leukocytosis and abnormal liver function tests being more common indicators, though patients with indwelling tubes may present without significant jaundice.

Purpose of the Study:

  • To review the evolving causes, clinical presentation, diagnosis, and management of cholangitis.
  • To highlight the shift in common etiologies of cholangitis towards iatrogenic causes.
  • To discuss current therapeutic strategies and prognostic factors in cholangitis.

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Main Methods:

  • Review of existing literature on cholangitis, focusing on changes in causative factors, diagnostic approaches, and treatment modalities.
  • Analysis of common pathogens, including shifts in microbial profiles in patients with indwelling tubes.
  • Evaluation of diagnostic imaging (computed cholangiography) and therapeutic interventions (antibiotics, biliary decompression).

Main Results:

  • Nonoperative biliary manipulations are now a leading cause of cholangitis, especially in specialized centers.
  • While common pathogens like E. coli persist, Enterobacter, Pseudomonas, and yeasts are increasingly isolated from patients with indwelling tubes, often with prior antibiotic exposure.
  • Computed cholangiography is crucial for diagnosing obstruction, with delayed imaging often feasible after initial treatment. Most patients (95%) survive cholangitis, with end-stage malignant obstruction being the main determinant of mortality.

Conclusions:

  • Cholangitis etiology has shifted, necessitating updated diagnostic and therapeutic approaches.
  • Prompt antibiotic therapy and appropriate biliary decompression, when required, are crucial for successful management.
  • While overall survival is high, the underlying cause of biliary obstruction significantly impacts patient outcomes.