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Recurrent cholangitis after biliary surgery.

L D Goldman, M L Steer, W Silen

    American Journal of Surgery
    |April 1, 1983
    PubMed
    Summary
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    Cholangitis after biliary-enteric anastomosis can occur without stoma obstruction. Predisposing factors include achlorhydria, duodenal diverticula, and foreign bodies, leading to infection in abnormal bile ducts.

    Area of Science:

    • Gastroenterology and Hepatology
    • Surgical Infections
    • Biliary System Pathophysiology

    Background:

    • Biliary-enteric anastomosis is a surgical procedure connecting the bile duct to the intestine.
    • Postoperative cholangitis, or bile duct inflammation, is a common complication.
    • It is typically attributed to stomal obstruction.

    Observation:

    • This study describes six patients who developed cholangitis without stomal obstruction after biliary-enteric anastomosis.
    • These patients presented with specific predisposing factors.
    • The intrahepatic biliary tree was abnormal in these cases.

    Findings:

    • Achlorhydria, duodenal diverticula, and foreign bodies were identified as significant predisposing factors.
    • Severe bacterial contamination in abnormal intrahepatic biliary trees can cause symptomatic biliary infection.

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  • This can occur even without evidence of extra-hepatic biliary obstruction.

    • Implications:

    • The findings challenge the assumption that stomal obstruction is the sole cause of cholangitis post-anastomosis.
    • Recognizing predisposing factors is crucial for diagnosing and managing cholangitis.
    • This highlights the importance of considering intrahepatic biliary tree abnormalities and bacterial contamination in the absence of overt obstruction.