Abstract
“Recurrent Pyogenic Cholangitis” (RPC) is a term that describes an advanced disease with intrahepatic stones and pus in the biliary tree. RPC occurs most frequently in Southeast Asia in patients of lower socioeconomic class who may have hepatic parasites and/or intrahepatic congenital biliary cysts. Up to two-thirds of Western patients with hepatolithiasis will present with cholangitis, and magnetic resonance imaging is recommended to establish a diagnosis. Management of cholangitis is standard with the exception that patients with recurrent episodes frequently will have resistant organisms and/or yeast. For isolated, especially left-sided, disease, lateral sectionectomy or left hepatectomy is recommended. However, the majority of patients will have bilateral disease without advanced fibrosis so liver transplantation is rarely indicated. In patients with bilateral hepatolithiasis, endoscopic management usually is not successful, but many of these patients can be treated by interventional radiologists (IR). When the stone burden is great, a combined IR and surgical (transhepatic team) approach is recommended. Intraoperative and postoperative choledochoscopy are key to this approach along with large-bore transhepatic stents which exit the liver and extend into a Roux-en-Y hepaticojejunostomy. With this “team approach” 90 % of patients remain symptom free without evidence of stone recurrence.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Jo JH, Chung MJ, Park JY, Bang S, Park SW, Lee WJ, et al. High serum CA 19-9 levels are associated with an increased risk of cholangiocarcinoma in patients with intrahepatic duct stones: a case-control study. Surg Endosc. 2013;27:4210–6.
Suzuki Y, Mori T, Yokoyama M, Nakazato T, Abe N, Tsubouchi H, et al. Hepatolithiasis: analysis of Japanese nationwide surveys over a period of 40 years. J Hepatobiliary Pancreat Sci. 2014;21:617–22.
Pitt HA, Venbrux AC, Coleman J, Presscott CA, Johnson MS, Osterman Jr FA, et al. Intrahepatic stones: the transhepatic team approach. Ann Surg. 1994;219:527–37.
Li SQ, Liang LJ, Peng BJ, Hua YP, Lv MD, Fu SJ, et al. Outcomes of liver resection for intrahepatic stones: a comparative study of unilateral versus bilateral disease. Ann Surg. 2012;255:946–53.
Lin CC, Lin PY, Ko CJ, Chen YL, Chen ST, Kuo SJ. Hepatic reaction for bilateral hepatolithiasis: a 20-year experience. ANZ J Surg. 2013;83:978–84.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Pitt, H.A. (2015). Commentary: Recurrent Pyogenic Cholangitis. In: Dixon, E., Vollmer Jr., C., May, G. (eds) Management of Benign Biliary Stenosis and Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-22273-8_9
Download citation
DOI: https://doi.org/10.1007/978-3-319-22273-8_9
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22272-1
Online ISBN: 978-3-319-22273-8
eBook Packages: MedicineMedicine (R0)