Recurrent pyogenic cholangitis: a necropsy study

Forty-six necropsy cases of recurrent pyogenic cholangitis (RPC) among Chinese in Hong Kong were reviewed. Intrahepatic biliary pigment stones or bile sludge were present in all cases and liver abscesses were common (80%). Histologically the early lesion was marked by acute inflammation in portal tracts with frequent pylethrombophlebitis and the advanced chronic lesion by periductal fibrosis. Most patients died from chronic persistent hepatic suppuration or disseminated infection. The pathogenesis is not fully understood; the present study favours the view that a protein-deficient diet initiates intrahepatic stone or sludge formation with biliary obstruction; subsequent bacterial infection probably originates from the portal system.