title: Endoscopic and radiologic interventions as the leading causes of severe cholangitis in a tertiary referral center.
abstract: BACKGROUND
  Iatrogenic factors became the leading mechanisms of severe cholangitis in a referral center.
  
  
  METHODS
  The records of the 58 patients treated for severe cholangitis between 1996 and May 2004 (inclusive) were evaluated.
  
  
  RESULTS
  The most frequent underlying diseases were periampullary tumors and mid-bile duct carcinomas (22), followed by proximal cholangiocarcinomas (14). The triggering mechanism was an incomplete endoscopic retrograde cholangiopancreatography (ERCP) in 32 patients, incomplete or inappropriate percutaneous transhepatic biliary drainage (PTBD) in 6, apparently successful ERCP and stenting in 1, and percutaneous transhepatic cholangiography in 1. PTBD was the treatment of choice (38). Mortality was 29% (17/58); the major causes were refractory sepsis (8) and incomplete biliary drainage (advanced tumor, technical failure, or hemobilia) (8).
  
  
  CONCLUSIONS
  In this series composed predominantly of patients referred after development of sepsis, ERCP and PTBD complications were the leading mechanisms of severe cholangitis. Nonoperative biliary manipulations are invasive procedures with potentially fatal complications. The decisions to perform such procedures and periprocedural management are responsibilities of an experienced multidisciplinary team.
authors.affiliation: Department of General Surgery, Hepatopancreatobiliary Surgery Unit, Istanbul University, Istanbul, Turkey. iozden@hotmail.com
authors.forename: Ilgin
authors.initials: I
authors.lastname: Ozden
authors.forename: Yaman
authors.initials: Y
authors.lastname: Tekant
authors.forename: Orhan
authors.initials: O
authors.lastname: Bilge
authors.forename: Koray
authors.initials: K
authors.lastname: Acarli
authors.forename: Aydin
authors.initials: A
authors.lastname: Alper
authors.forename: Ali
authors.initials: A
authors.lastname: Emre
authors.forename: Izzet
authors.initials: I
authors.lastname: Rozanes
authors.forename: Halit
authors.initials: H
authors.lastname: Ozsut
authors.forename: Orhan
authors.initials: O
authors.lastname: Ariogul
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D002758:Cholangiography / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000209:etiology*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology