Recurrent Pyogenic Cholangitis: Pathology, Imaging, and Management by Interventional Radiology

Abstract

Recurrent pyogenic cholangitis (RPC), also known as oriental cholangiohepatitis, oriental cholangitis, primary cholangitis, and intrahepatic pigment stone disease, is a distinct clinical entity characterized by recurrent attacks of fever, chills, abdominal pain, and jaundice caused by bacterial infection to the biliary tree (Cook et al. 1954; Ong 1962; Seel and Park 1983; Carmona et al. 1984). The intra- and extrahepatic bile ducts show dilatation and stricture, and they may contain calculi, debris consisting mainly of bile pigments, epithelial cells, and mixed exudates, and sometimes frank pus. Intrahepatic stones are usually multiple, soft, muddy, and often tenaciously adherent to the duct wall. These stones cause progressive biliary obstruction and recurrent infection, resulting in the formation of multiple cholangitic abscesses, biliary strictures, and eventually severe destruction, cirrhosis, and portal hypertension (Fan et al. 1991).