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PubMed1985

[The clinical and pathologic correlations in acute cholangitis].

The liver histology of acute cholangitis was studied in order to determine whether microscopic changes correspond to clinical status. Patients with acute cholangitis were divided into mild cholangitis (1st group, n = 18) and severe cholangitis (2nd, 3rd and 4th groups) accompanied by hypotension. The 2nd group consisted of 6 surviving patients who underwent liver biopsy during hypotension. The 3rd group consisted of 3 non-surviving patients with biopsy during hypotension. The 4th group consisted of 7 patients with biopsy during autopsy. The frequency of endotoxemia, gram negative bacteremia, disseminated intravascular coagulopathy and hepatic failure were significantly higher in severe cholangitis than in mild cholangitis. The incidence of neutrophilic infiltration in the sinusoid and microabscess in lobule were significantly higher in severe cholangitis than in mild one. The incidence of portal thrombosis and massive necrosis of hepatic cells were also significantly higher in severe cholangitis, especially in the 3rd and 4th groups. It was suggested that the neutrophilic infiltration in the sinusoid and microabscess in lobules which proved the existence of endotoxemia or bacteremia were characteristic findings in severe cholangitis.

Acute Disease↗
PubMedDate not supplied

Enhanced autoreactivity of T-lymphocytes in primary sclerosing cholangitis.

Primary sclerosing cholangitis is a chronic, cholestatic liver disease in which immune mechanisms are thought to play a role in the pathogenesis. We have determined the frequencies and functional phenotypes of autoreactive T-lymphocytes in peripheral blood specimens from patients with primary sclerosing cholangitis and healthy adults as an indicator of autoreactivity in primary sclerosing cholangitis. We found a significant increase in the percentage of autoreactive suppressor/cytotoxic T-lymphocytes that become activated in the T-, non-T-autologous mixed lymphocyte reaction in primary sclerosing cholangitis patients (p less than 0.002). Blastogenesis in autologous mixed lymphocyte reaction cultures from primary sclerosing cholangitis patients was significantly decreased (p less than 0.02), and the magnitude of the decrease correlated directly with the percentage of activated suppressor/cytotoxic T-lymphocytes (r = 0.56, p less than 0.01). The percentage of autoreactive, suppressor T-lymphocytes was increased in autologous mixed lymphocyte reaction cultures from primary sclerosing cholangitis patients (p less than 0.0001); and suppression of mitogen-induced blastogenesis by autologous concanavalin A-treated mononuclear cells was significantly enhanced. These results, which were unrelated to the histologic stage of liver disease and the presence or absence of active colitis, document the presence of an expanded population of T-lymphocytes in the peripheral blood of patients with primary sclerosing cholangitis that became activated on exposure to autologous major histocompatibility antigens in the autologous mixed lymphocyte reaction. We hypothesize that these autoreactive cells may be a marker or may participate as effector cells in cell-mediated autoimmunity in primary sclerosing cholangitis.

Adult↗
PubMed1998

Cytokine production from colonic T cells in patients with ulcerative colitis with and without primary sclerosing cholangitis.

PURPOSE: Only five percent of all patients with ulcerative colitis develop primary sclerosing cholangitis. T cells accumulate at the sites of the colonic and bile duct inflammation in both ulcerative colitis and primary sclerosing cholangitis. T helper cell populations comprise functionally distinct subsets characterized by the cytokines they produce. Several alterations in cytokine production have been described in patients with ulcerative colitis. The aim of this study was to investigate possible differences in T helper subsets and cytokine production in peripheral blood and colonic mucosa among ulcerative colitis patients with and without primary sclerosing cholangitis. METHODS: Eleven patients with primary sclerosing cholangitis and extensive ulcerative colitis, 11 patients with extensive ulcerative colitis and no liver disease, and 5 patients without any history of liver disease who underwent routine colonoscopy because of previous polypectomy were included in the study. Colonoscopy with multiple biopsies was performed on all patients. Lamina propria mononuclear cells and peripheral blood mononuclear cells were isolated. A modified version of solid-phase enzyme-linked immunospot assay was used for the separate counting of cells producing interferon-gamma, interleukin-2 (T helper 1), and interleukin-4 (T helper 2). RESULTS: No differences in spontaneous production of cytokines from peripheral blood mononuclear cells was found among the three groups. Patients with primary sclerosing cholangitis compared with patients with ulcerative colitis without liver disease showed a significant increase in the number of cells secreting interferon-gamma after purified protein derivative stimulation (P < 0.02). More cells secreting interferon-gamma were found in the two ulcerative colitis groups than in the cell populations from healthy controls (P < 0.03). The number of cells secreting interferon-gamma in the primary sclerosing cholangitis group was significantly lower than in the ulcerative colitis group without liver disease (P < 0.04). The number of cells secreting interleukin-4 was lower in the primary sclerosing cholangitis group than among the patients with ulcerative colitis only (P = 0.05). CONCLUSION: Isolated lymphocytes from colonic mucosa differ in cytokine production in patients with ulcerative colitis with and without primary sclerosing cholangitis.

Cholangitis, Sclerosing↗
PubMed2005

Efficacy of urinary sulfated bile acids for diagnosis of bacterial cholangitis in biliary atresia.

This study evaluated the efficacy of measuring urinary sulfated bile acids (USBA) for diagnosis of bacterial cholangitis in patients with biliary atresia. Eight infants with biliary atresia were recruited. The USBA level was measured when they were admitted to hospital with a fever of unknown origin. Clinical manifestations and laboratory data were reviewed. The standard USBA value for each patient (S-USBA) was defined as the level measured when they had no fever, and USBA ratio (R-USBA) was calculated as the USBA level during the febrile episode divided by the S-USBA. Then R-USBA values were compared between febrile episodes with and without cholangitis to assess the diagnostic ability of USBA. Twenty-three febrile episodes occurred in eight patients during a 15-month period. Nine episodes were diagnosed as being due to cholangitis, five were due to non-cholangitis, and nine were of undetermined origin. The R-USBA value ranged from 1.5 to 15.4 during cholangitis episodes and from 0.4 to 1.2 during non-cholangitis febrile episodes. When fever was of undetermined origin, R-USBA was found to be increased during some episodes and not in others. USBA increased immediately in patients with cholangitis. The measurement of USBA is a useful non-invasive test for cholangitis in patients with biliary atresia who had undergone Kasai's operation.

Bacterial Infections↗
PubMed1999

Etiology and natural history of primary sclerosing cholangitis.

The etiology of primary sclerosing cholangitis remains unknown. Bacteria, toxins, viral infections, and immunological and genetic factors have all been proposed as etiological agents. Portal bacteremia, toxins absorbed from the diseased colon in inflammatory bowel disease, and cytomegalovirus and reovirus infections have been implicated by various investigators but there is little evidence to support these hypotheses. The close association between primary sclerosing cholangitis and various human leukocyte antigen haplotypes is now well established and lends support to the theory that immunologic and genetic mechanisms may be involved in its pathogenesis. Patients with primary sclerosing cholangitis may have elevated levels of circulating immune complexes, immunoglobulins, and non-organ specific autoantibodies. The association between ulcerative colitis and primary sclerosing cholangitis remains unexplained and both groups of patients have a high prevalence of antibodies to the perinuclear cytoplasmic antigen. The long-term prognosis in primary sclerosing cholangitis is tempered by the development of cholangiocarcinoma in 6%-30% of patients when followed over long periods of time. Detecting cholangiocarcinoma early in a patient with primary sclerosing cholangitis is one of the most frustrating problems faced by a clinician while caring for these patients. The long-term outlook for patients with primary sclerosing cholangitis and cholangiocarcinoma remains dismal, whatever the treatment modality employed. However, the development of a multivariate statistical survival model from long-term survival data from the Mayo Clinic and other centers has been a major step in identifying individual primary sclerosing cholangitis patients at low, moderate, and high risk of dying. Such models have been useful for stratifying patients in therapeutic trials, for in patient counseling, and in patient selection and timing of liver transplantation.

Cholangitis, Sclerosing↗
PubMed2004

Cholangitis as a late complication in long-term survivors after surgery for biliary atresia.

BACKGROUND/PURPOSE: A retrospective review was performed to assess the utility of diagnostic imaging (DI), efficacy of treatment, and outcome of late cholangitis in long-term survivors after surgery for biliary atresia. METHODS: Sixty-one patients surviving without liver transplantation (LTx) for more than 20 years were divided into 2 groups depending on whether cholangitis developed after age 20. Clinical factors including the type of obstruction, the age at the initial operation, and the early complication with cholangitis were compared between the 2 groups. DI such as computed tomography scan and magnetic resonance imaging, clinical courses after treatment of cholangitis, and current status of the patients were also evaluated. RESULTS: Thirteen patients had cholangitis after age 20. There was no statistical difference in the clinical factors studied between the 2 groups. Abnormal DI findings including dilatation of intrahepatic bile ducts and hepatic fibrosis were seen in 10 patients with late cholangitis. One patient died, and 2 ultimately underwent LTx. The remaining 10 patients including 4 with normal or near-normal liver function have survived without LTx. CONCLUSIONS: Although the majority of the patients had potential predisposing factors for cholangitis such as dilatation of intrahepatic bile ducts, a few patients unexpectedly had cholangitis without such abnormal findings after an excellent, long-term postoperative course.

Adult↗
PubMedDate not supplied

Diagnosis and management of cholangiocarcinoma in primary sclerosing cholangitis.

Cholangiocarcinoma remains difficult to diagnose and is a major cause of death in patients with primary sclerosing cholangitis. Recently serum carcinoembryonic antigen and carbohydrate antigen 19-9 (CA 19-9) levels have been reported to improve diagnostic accuracy in patients with cholangiocarcinoma and primary sclerosing cholangitis. We reviewed our experience with cholangiocarcinoma complicating primary sclerosing cholangitis to identify clinical factors associated with cholangiocarcinoma in patients with primary sclerosing cholangitis and to determine the appropriate management of patients with confirmed or suspected cholangiocarcinoma. Between 1984 and 1997, 25 patients (18%) were diagnosed with cholangiocarcinoma among 139 patients with primary sclerosing cholangitis. The diagnosis of primary sclerosing cholangitis was made coincident with the diagnosis of cholangiocarcinoma in 12 patients and preceded it by a mean of 62 months in the remaining 13 patients. The incidence of inflammatory bowel disease was higher (P <0.05) in patients with cholangiocarcinoma (80% vs. 61%). Nine patients (36%) with cholangiocarcinoma were managed with either extrahepatic bile duct resection and/or partial hepatic resection (n = 5) or liver transplantation (n = 4), and the remaining 16 patients were unresectable at presentation. Serum CA 19-9 was elevated in all six patients with cholangiocarcinoma who were analyzed and in none of the eight patients without cholangiocarcinoma who were tested (P <0.01). Actuarial 1- and 3-year survival rates in the resected patients (56% and 28%, respectively) were significantly longer (P <0. 02) than in the unresected patients (13% and 0%, respectively). The 10-year actuarial mortality rates for cholangiocarcinoma among all 139 patients was 25%. In summary, cholangiocarcinoma was the leading cause of death in patients with primary sclerosing cholangitis and was often diagnosed concurrently with or within months of its diagnosis. Early liver transplantation for patients with primary sclerosing cholangitis will not reduce the incidence of cholangiocarcinoma-related mortality in these patients.

Actuarial Analysis↗
PubMed1999

Bacteribilia and cholangitis after percutaneous transhepatic biliary drainage for malignant biliary obstruction.

Cholangitis often develops after percutaneous transhepatic biliary drainage (PTBD) for malignancy. The aims of this retrospective study were to clarify whether or not bacteribilia and cholangitis increase with time after PTBD and to define the pathogenesis of bacteribilia and cholangitis after PTBD. One hundred twenty-eight patients underwent PTBD for malignancy. Both the cumulative incidences of bacteribilia (77%) and cholangitis (28%) showed an increase with time after PTBD. In 78% of patients with bacteribilia, bacteria from intestinal flora were detected in bile. Catheter malfunction (N = 17) or the presence of undrained bile ducts (N = 7) induced cholangitis. Proximal obstruction, because it often accompanied undrained ducts, had higher incidences of bacteribilia (P = 0.04) and cholangitis (P < 0.0001) than did distal obstruction. In conclusion, bacteribilia and cholangitis increase in incidence with time after PTBD. The primary cause of bacteribilia is the transpapillary reflux of intestinal flora. Catheter malfunction or undrained ducts cause cholangitis, provided underlying bacteribilia is present.

Bile↗
PubMed2000

Expression of p53 and PCNA in cholangiocarcinoma and primary sclerosing cholangitis.

The aim of this study was to identify the pattern and significance of expression of p53 and PCNA in cholangiocarcinoma and primary sclerosing cholangitis. Histological sections from 18 patients with cholangiocarcinoma (3 of the cases were associated with primary sclerosing cholangitis), 10 patients with primary sclerosing cholangitis without cholangiocarcinoma, and 7 patients with cirrhosis without cholangiocarcinoma or primary sclerosing cholangitis were stained immunohistochemically for p53 and PCNA. Samples from 17 patients with cholangiocarcinoma (94%) stained positively for p53. Among these 17 cases, nontumorous bile duct epithelium was positive in 7 (including 3 cases with primary sclerosing cholangitis and 2 with carcinoma in situ), and were positive proliferating bile ductules in 4 cases. The single p53-negative cholangiocarcinoma did not show p53 positivity in either the bile duct epithelium or the proliferating bile ductules. Bile ductal and ductular cells in all 10 patients with primary sclerosing cholangitis without cholangiocarcinoma and in the 7 controls were not reactive for p53. All 18 samples from patients with cholangiocarcinoma (100%) were positive for PCNA protein. Bile duct epithelium was positive for PCNA in nine cases (90%) of primary sclerosing cholangitis without cholangiocarcinoma and in six (85%) controls. Our study showed a high rate of p53 expression (94%) in cholangiocarcinoma. The adjacent uninvolved bile duct epithelium was also immunoreactive for p53 in 7 of 17 patients (41%). These findings suggest an early p53 mutation in bile ductal cells in cholangiocarcinogenesis. Expression of p53 may potentially be used to identify or screen, by bile duct brushings, cases of primary sclerosing cholangitis suspected of harboring cholangiocarcinoma. Expression of PCNA was a universal feature in cholangiocarcinoma.

Bile Duct Neoplasms↗
PubMed2001

Sclerosing cholangitis in the paediatric patient.

Sclerosing cholangitis in childhood is a heterogeneous condition, which has different aetiologies. Sclerosing cholangitis may be inherited and diagnosed in the neonatal period (neonatal sclerosing cholangitis); it may present later with features of autoimmunity (autoimmune sclerosing cholangitis); or it may be associated with a variety of disorders, including Langerhans cell histiocytosis, immunodeficiency, psoriasis, cystic fibrosis, reticulum cell sarcoma and sickle cell anaemia. In contrast to the experience in adult patients, sclerosing cholangitis occurring as an individual disease (primary sclerosing cholangitis) is rare. The initiating events and possible pathogenic mechanisms differ in the various forms of sclerosing cholangitis and are still obscure. Treatment and prognosis depend on the type of sclerosing cholangitis present.

Adolescent↗
PubMed1987

Endoscopic sphincterotomy as a therapeutic measure in cholangitis and as prophylaxis against recurrent biliary tract stones.

Our purpose was to analyse the results of endoscopic sphincterotomy in patients with advanced cholangitis, and to assess the potential of this method in the prevention of recurrent biliary tract stones. Advanced cholangitis certainly predisposes to microlith formation, and we believe that the increased biliary drainage produced by sphincterotomy counteracts this process. Our grading of cholangitis was an intraoperative cholangioscopic assessment corresponding to Nishimura grades III and IV (erosions in the duct walls, patchy stone ulceration, biliary gravel, fibro-purulent plaques densely adherent to the biliary walls etc. 62 patients with grades III and IV cholangitis (as defined at choledochoscopy) underwent endoscopic sphincterotomy (GP-A). This group underwent a controlled prospective study with review at: one year, between 2 and 3 years, 5 years following surgery. The control group (GP-B) constituted 20 patients with comparable cholangitis who did not undergo sphincterotomy. Group A had no recurrent lithiasis, 4.8% revealed persistent cholangitis. In control group (GP-B) 6 patients (30%) revealed recurrent lithiasis, on average 4.6 years following initial surgery. In addition, 35% of this group had clinical symptoms of cholangitis. These results indicate that endoscopic sphincterotomy is a worthwhile method in the treatment of cholangitis and prophylaxis against recurrent biliary tract stones.

Ampulla of Vater↗
PubMed1999

The influence of cholangitis on the prognosis of extrahepatic biliary atresia.

The prognosis of extrahepatic biliary atresia (EHBA) depends first on the progression of the basically existing disease and second on the development of preoperative existing alterations of hepatic structure. In addition there are postoperative complications which have essential influence on the prognosis of the disease. In this context ascending cholangitis poses a very important problem for children who have undergone a portoenterostomy. Both the organism and the frequency of cholangitis may play a part. This study should outline the influence of cholangitis on the prognosis. Since 1972, 146 cases of extrahepatic biliary atresia have been treated and followed up postoperatively. Children with a liver fibrosis degree IV at surgery will develop a cirrhosis in 86% of cases without additional influence of cholangitis. Children with a liver fibrosis degree II/III will develop a cirrhosis in 20% of cases without the influence of cholangitis after 15 years. But children with a fibrosis degree II/III with one or several episodes of cholangitis will develop a liver cirrhosis in 50% of cases after 12.5 years. The difference is statistically significant. In addition the frequency of cholangitis is also an important factor: The more episodes of cholangitis the greater the probability of cirrhosis.

Biliary Atresia↗
PubMed2004

Risk factors for recurrent cholangitis after initial hepatolithiasis treatment.

GOALS: To elucidate the risk factors that can affect the rate of cholangitis after hepatolithiasis treatment. BACKGROUND: Hepatolithiasis is prevalent in East Asia and causes long-term complications. Recurrent cholangitis is one of its most serious complications and can lead to biliary stricture, liver cirrhosis, and even cholangiocarcinoma. However, little is known about the risk factors associated with cholangitis. STUDY: The clinical records of 193 patients with hepatolithiasis who had been newly diagnosed and treated were reviewed. The mean follow-up was 56 months (1-242 months). RESULTS: Cumulative cholangitis rates were 25.0% at 3 years and 37.0% at 5 years. By multivariate analysis, cholangitis was associated with hepatic resection (Hazard ratio [HR] = 0.28; 95% confidence interval [CI]: 0.12-0.65), residual stones (HR = 1.77; 95% CI: 1.05-2.98), and recurrent stones (HR = 4.02; 95% CI: 1.31-12.36), but not Sphincter of Oddi disruption. Though biliary stricture did not in general affect the cholangitis rate, a stricture located in the common hepatic or common bile duct was associated with a higher rate of cholangitis than a stricture in the intrahepatic duct alone. CONCLUSIONS: Cholangitis occurs frequently in hepatolithiasis patients with a common hepatic or common bile duct stricture, residual stones, recurrent stones, and in those that are treated by nonhepatic resection.

Adolescent↗
PubMed1996

Absence of antineutrophil cytoplasmic antibodies in relatives of UK patients with primary sclerosing cholangitis and ulcerative colitis.

OBJECTIVE: Perinuclear antineutrophil cytoplasmic antibodies (ANCA) have been reported in patients and relatives of patients with ulcerative colitis and primary sclerosing cholangitis, suggesting that ANCA may be a genetic marker of disease susceptibility. The reported frequency of ANCA in relatives has varied greatly, between 0 and 30%. We therefore studied the prevalence of ANCA in unaffected first-degree relatives of British patients with primary sclerosing cholangitis and ulcerative colitis. DESIGN: Thirty-six patients with ulcerative colitis, 33 with primary sclerosing cholangitis and 187 relatives were studied. Ninety-seven relatives were from the primary sclerosing cholangitis proband and 90 were from the ulcerative colitis proband. As an environmental control, 32 spouses were included: 14 from the primary sclerosing cholangitis group and 18 from the ulcerative colitis group. Eighteen healthy volunteers were additional controls. METHODS: ANCA was detected using immunoalkaline phosphatase method. RESULTS: Only 3 of 97 (3%) of the primary sclerosing cholangitis proband relatives had ANCA. One of these had ulcerative colitis, one had rheumatoid arthritis and the third systemic lupus erythematosus. Both rheumatoid arthritis and system lupus erythematosus are known to exhibit ANCA. All other sera were negative. CONCLUSION: ANCA was found only in patients with primary cholangitis and ulcerative colitis and not in their healthy first-degree relatives. ANCA is therefore not a genetic marker for increased disease susceptibility to primary sclerosing cholangitis or ulcerative colitis in the British population.

Adult↗
PubMed1985

Nonoperative dilatation of dominant strictures in primary sclerosing cholangitis.

While most cases of primary sclerosing cholangitis are characterized by multifocal bile duct strictures, a few have a localized high-grade stricture (dominant stricture) superimposed on diffuse disease. This dominant stricture may cause jaundice or bacterial cholangitis in some patients. Dominant strictures were percutaneously dilated in 14 patients with primary sclerosing cholangitis and jaundice or bacterial cholangitis. Stricture dilatation produced a significant decrease in the frequency of cholangitis and a significant decrease in serum bilirubin in those with recent onset of jaundice. The only complication was bacteremia or cholangitis in five patients. Three of nine patients with successful dilatations developed recurrent strictures at 6-18 months. Balloon dilatation should be considered the treatment of choice for dominant strictures in symptomatic patients with primary sclerosing cholangitis who have recent onset of jaundice (less than 6 months' duration) or recurrent episodes of bacterial cholangitis.

Cholangiography↗
PubMed1993

Biliary strictures in hepatic transplants: prevalence and types in patients with primary sclerosing cholangitis vs those with other liver diseases.

OBJECTIVE: The purpose of this study was to determine the prevalence and types of biliary strictures seen in liver allografts transplanted for primary sclerosing cholangitis and other end-stage liver diseases and to determine if such strictures occur more often in the allografts transplanted for primary sclerosing cholangitis than in the others. MATERIALS AND METHODS: During a 10-year period, 643 liver transplantation patients (687 allografts) with choledochojejunostomy biliary anastomoses underwent 1728 cholangiographic studies. Three hundred six cholangiograms were obtained in 100 transplant recipients who had primary sclerosing cholangitis (112 allografts) and 1422 cholangiograms were obtained in 543 recipients who had other liver diseases (575 allografts). We retrospectively reviewed all cholangiograms of transplant recipients who had primary sclerosing cholangitis and 909 cholangiograms of the recipients who had other liver diseases and a diagnosis of biliary strictures, possible biliary strictures, or duct irregularity based on radiologic reports. The presence, number, and locations of strictures were recorded. The remaining 513 cholangiograms of recipients with other liver diseases without strictures were not reviewed. Biliary strictures were classified as intrahepatic (including bifurcation), anastomotic, and nonanastomotic extrahepatic. RESULTS: Cholangiograms showed intrahepatic biliary strictures in 105 allografts (15%), anastomotic strictures in 105 allografts (15%), and nonanastomotic extrahepatic biliary strictures in 17 allografts (2%). Intrahepatic biliary strictures were diagnosed in 27% (30/112) of the allografts transplanted for primary sclerosing cholangitis and in 13% (75/575) of the allografts transplanted for other end-stage liver diseases (p = .0005). Anastomotic strictures developed in 18% (20/112) of the allografts transplanted for primary sclerosing cholangitis and in 15% (85/575) of the others (p = .381). Nonanastomotic extrahepatic strictures were seen in 6% (7/112) of the allografts transplanted for primary sclerosing cholangitis and in 2% (10/575) of the others (p = .008). CONCLUSION: Intrahepatic and nonanastomotic extrahepatic biliary strictures are significantly more common in patients who have liver transplantation for primary sclerosing cholangitis than in patients who receive allografts for other end-stage liver diseases. However, strictures at the choledochojejunostomy anastomosis occur with equal frequency in both groups of patients.

Adolescent↗
PubMed1991

Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.

All patients greater than or equal to 16 years old with a diagnosis of ulcerative colitis were identified in five well-defined catchment areas, representing 12.7% of the Swedish population. Exactly 1500 patients were retrieved, giving a point prevalence of 170/10(5) inhabitants. It was possible to obtain liver function test results less than 2 years old in 94% of the patients and to obtain endoscopic retrograde cholangiographic results in 65 of the 72 patients with abnormal serum alkaline phosphatase values. Primary sclerosing cholangitis was diagnosed in 55 of the patients (3.7%). The prevalence of the disease was 5.5% in patients with substantial colitis and 0.5% in patients with distal colitis. There was a marked male predominance in cholangitis patients compared with colitis patients without cholangitis. Ninety-five percent of the patients with cholangitis had substantial colitis, which was more than the 62% of patients without cholangitis who had colitis. Female patients with cholangitis were older than male patients at the time of diagnosis of both cholangitis and colitis, which contrasted to the equal age at diagnosis of colitis in male and female patients without cholangitis.

Adolescent↗
PubMed1983

Consequences of preoperative cholangitis and its treatment on the outcome of operation for choledocholithiasis.

During a 30-month period 73 patients underwent operation for choledocholithiasis. Thirty-three of these patients (45%) had cholangitis preoperatively. When compared to patients with common duct stones who had no preoperative cholangitis, patients with cholangitis were older (P less than 0.001), more likely to present with jaundice (P less than 0.01) and leukocytosis (P less than 0.01), and more likely to have retained or primary common duct stones (P less than 0.01). Cholangitis patients were also more likely to have bactibilia (P less than 0.025), and anaerobes were isolated from the bile of 27% of these patients (P less than 0.01). Twenty-nine of 33 cholangitis patients (88%) received a minimum of 4 days of broad-spectrum antibiotics including an aminoglycoside prior to operation (P less than 0.01). Despite these clear differences, patients with preoperative cholangitis were not more likely to develop infective sequelae or biliary complications. However, cholangitis patients were much more likely (P less than 0.001) to develop an increase in serum creatinine (33% versus 3%) which, in turn, contributed to a longer (P less than 0.01) postoperative hospitalization. Since therapy with aminoglycosides may have contributed to postoperative morbidity and prolonged hospital stay, aminoglycosides should be reserved only for patients with the most severe cholangitis and should be used with great caution.

Adolescent↗