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Childhood recurrent pyogenic cholangitis.

H Saing1, P K Tam, T K Choi

  • 1Department of Surgery, University of Hong Kong, Queen Mary Hospital.

Journal of Pediatric Surgery
|May 1, 1988
PubMed
Summary
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Recurrent pyogenic cholangitis (RPC) in children often presents with severe infection. Surgical decompression and drainage procedures, alongside antibiotic therapy, are crucial for managing this condition and its associated biliary stones.

Area of Science:

  • Pediatric Surgery
  • Hepatobiliary Surgery
  • Gastroenterology

Background:

  • Recurrent pyogenic cholangitis (RPC) involves repeated bacterial infections of the bile ducts.
  • It leads to strictures and gallstones in both intrahepatic and extrahepatic bile ducts.
  • Children with RPC typically present with acute illness and septicemia.

Purpose of the Study:

  • To review the management and outcomes of ten children with recurrent pyogenic cholangitis (RPC) treated between 1973 and 1984.
  • To evaluate the effectiveness of surgical and medical interventions for RPC in pediatric patients.
  • To highlight the challenges and advancements in managing biliary tract infections and stones in children.

Main Methods:

  • Retrospective analysis of ten pediatric cases of RPC managed over an 11-year period.

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  • Description of initial presentations, including acute illness and septicemia.
  • Details of surgical interventions: emergency decompression, definitive drainage procedures (sphincteroplasty, choledochoduodenostomy), and T-tube drainage.

    • Main Results:

    • Four children initially responded to intravenous fluid and antibiotic therapy, with three later needing sphincteroplasty.
    • Six children required emergency surgical decompression; three of these also underwent definitive drainage.
    • All patients had pigment stones or mud in the bile ducts; long-term follow-up (3-12 years) showed most patients are well, with one operative death.

    Conclusions:

    • RPC in children is a serious condition requiring prompt and often aggressive management.
    • Surgical decompression and drainage are essential for managing acute RPC and associated biliary stones.
    • Advances like ERCP and intraoperative choledochoscopy have improved diagnosis and stone removal in RPC management.