[Suppurated acute obstructive cholangitis. Anatomoclinical and therapeutic aspects].

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Pathology
• Biliary Tract Diseases

Context:

• Focuses on 134 surgical cases of suppurated acute obstructive angiocholitis over 10 years.
• Represents 12.8% of all hepato-choledochal obstructions.
• Highlights the significant prevalence of severe, ictero-uremic forms (50.7%) with a high mortality rate (34%).

Purpose:

• To analyze the etiopathogenic mechanisms of obstructive angiocholitis.
• To evaluate surgical treatment outcomes for this condition.
• To emphasize the necessity of early, intensive, and tailored medico-surgical management.

Summary:

• Etiologies included biliary lithiasis (59 cases), cancers (40), hepatic hydatitosis (16), Vater ampuloma (10), Oddi sphincter sclerosis (5), congenital choledochal cyst (1), and postoperative stenosis (2).
• Various surgical procedures were performed: evacuation choledocotomy (22 cases), choledocho-duodenal anastomosis (46), Oddi sphincterotomy (12), ampulectomy (5), and peripheral bilio-digestive anastomoses (40).
• Mortality rates varied by procedure, with 3 deaths in choledocotomy, 10 in choledocho-duodenal anastomosis, 2 in sphincterotomy, 2 in ampulectomy, and 5 in bilio-digestive anastomoses.

Impact:

• Underscores the critical need for early and complex surgical intervention in obstructive angiocholitis.
• Demonstrates the importance of adapting surgical strategies to specific patient anatomoclinical presentations.
• Provides insights into the efficacy and risks associated with different surgical approaches for biliary obstruction.