Duodenoscopic sphincterotomy for acute suppurative cholangitis.
Fifteen patients (eight males, seven females; age range: 23-76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1-10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall-bladders in situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile-duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall-bladders in situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3-26 months (mean follow-up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is performed early.
Tandon
R K
RK
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi.
Saraswat
V A
VA
Kapur
B M
BM
Vashisht
S
S
D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology / Q000601:surgery*; D004384:Duodenoscopy; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013105:Sphincterotomy, Transduodenal