The clinical and pathologic correlations in mechanical biliary obstruction and acute cholangitis

Recently reported series of patients with cholangitis have shown no consistently recognizable differences in clinical presentation between patients with and patients without purulence in the biliary tree, in spite of a clearly higher mortality associated with suppurative cholangitis. To determine whether microscopic changes in the liver ductular system more accurately correspond to clinical status than does the gross finding of suppuration in the common bile duct, a retrospective study was made of 70 patients operated upon for mechanical biliary obstruction and in whom liver biopsy was obtained. Forty patients had benign obstruction, and 30 had malignant disease. The severity of morphologic cholangitis in liver biopsies was graded in a semiquantitative fashion based on inflammatory changes within the portal triads. No significant correlation (chi-square analysis) was found between liver histology and clinical presentation, laboratory data, or mechanism of biliary obstruction. In fact, three patients exhibiting clinical cholangitis had but mild histologic changes; conversely, four patients with minimal symptoms had multiple hepatic microabscesses. The clinical presentations of patients with mechanical biliary obstruction fail to correspond uniformly to either gross or microscopic pathologic findings in the biliary tree. Symptoms and signs of cholangitis may be attributed to some other as yet undefined factors.