Early diagnosis and treatment of severe acute cholangitis.
OBJECTIVE
To investigate the diagnostic standard for early identification of severe acute cholangitis in order to lower the incidence of morbidity and mortality rate.


METHODS
A diagnostic standard was proposed in this study as follows:documented biliary duct obstruction by ultrasound or computerized tomography or other imaging tools with the manifestation of systemic inflammatory response syndrome (SIRS). The surgical procedures included emergency common bile duct exploration with T tube insertion or cholecystostomy with secondary common bile duct exploration. And incidence of postoperative multiple organ dysfunction syndrome (MODS), duration of systemic inflammatory response and hospital mortality were analyzed.


RESULTS
Fourty-three patients conforming to the diagnostic standard described above were employed in this study. 1 patient was admitted in acutely ill condition and complicated with acute relapse of chronic bronchitis, cholecystostomy procedure was performed but the patient was complicated with postoperative acute lung injury which was treated by assisted mechanical ventilation for 5 d; 2 wk later, two-stage common bile duct Exploration and T tube insertion were performed. The remaining 42 patients underwent primary common bile duct exploration and T tube insertion, 1 developed acute lung injury and recovered 3 d later, 2 patients developed acute renal dysfunction, 1 of which recovered 2 d later and the other died on d 4. For all patients, the postoperative systemic inflammatory response persisted for 2 to 8 d with median of 3 d.


CONCLUSIONS
Early diagnosis of severe acute cholangitis can be made using this diagnostic standard, further development of systemic inflammatory response could be prevented and incidence of MODS as well as hospital mortality decreased.
Zhang
Wei-Zhong
WZ
Department of Surgery, Huangyan First Hospital, Huangyan 318020, Zhejiang Province,China. pgmh@mail.tzptt.zj.cn
Chen
Yi-Shao
YS
Wang
Jin-Wei
JW
Chen
Xue-Rong
XR
D000208:Acute Disease; D000368:Aged; D002761:Cholangitis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies