[The choice of the operation and management in cholangitis]

Irrespective of the high rate of bacterial flora (intestinal, respectively) penetration into the biliary apparatus, clinically manifested cholangitis cases are relatively seldom met with. The predisposing factors involved are: penetration of virulent flora (anaerobic inclusive) into the bile ducts, presence of conditions promoting delay or discontinuation of the bile passage (biliary hypertension), and longstanding of the disease. Cholangitis associated with cholangiohepatitis development is one of the severest conditions of cholelithiasis (ChL), being observed as an independent nosological entity also. Over the period 1974 through 1993, in the clinic of abdominal surgery a total of 144 patients presenting cholangitis undergo treatment, of which in 74 (8.7 per cent) it is associated with ChL, in 58 it is discovered during reoperation on the biliary apparatus, and in twelve it is diagnosed as an independent disease, unrelated to calculosis. Acute cholangitis runs a foudroyant course with a poor prognosis, whereas the chronic form is characterized by larvate (masked) development with exacerbation periods. The clinical picture is dominated by Charcot's triad. The disease runs a rather severe course in the contingent liable to reoperation. As a rule, it occurs as the result of stricture of the bile ducts or obliteration of bilidigestive anastomosis. 58 per cent of the patients are older than 50 years. Operative intervention in acute cholangitis should be done on an emergency basis. External drainage insertion is a palliative measure, practicable in heavily damaged patients. The operation in acute and chronic cases is aimed at maximum possible healing of the biliary tract and elimination of the underlying causes of obstructed passage. Lethality is higher than the medium rate, and the prognosis remains serious.