Bile ductular cholestasis: an ominous histopathologic sign related to sepsis and "cholangitis lenta"

An unusual form of intrahepatic cholestasis manifested by inspissated bile within dilated and proliferated portal and periportal bile ductules was seen in liver biopsy and autopsy specimens from three patients. Features of sepsis and sever systemic illness with jaundice dominated their clinical presentations, and no autopsy evidence of large bile duct obstruction could be found. This lesion may be related to the old entity, "cholangitis lenta," a form of chronic sepsis associated with biliary tract inflammation in the absence of demonstrable extrinsic obstruction. Identification of this pattern of cholestasis in liver biopsy specimens is useful in certain patients who may be a great risk of mortality and who require serous clinical attention directed toward elucidating a source for sepsis as well as aggressive management of other systemic disease. Laparotomy in such cases will be unrewarding and may hasten the patient's demise.