ABSTRACT
Objective To evaluate the application of endoscopic needle- knife precut sphincterotomy (PST) in treating acute suppurative cholangitis. Methods After failure of routine papillary intubation during encoscopic retrograde cholangio-pancreatography (ERCP) in papillary incarcerated stone or inflammatory stenosis cases, needle-knife PST was applied to find the lower opening of the common bile duct. After that, routine papillary sphincterotomy or balloon dilation followed. Then net basket for stone extraction and nasobiliary catheter for drainage were made. Results Eleven of the 12 cases′ stones were extracted successfully, the success rate was 91.7%. In the 11 cases, 5 cases′ incarcerated stones dropped into duodenum automatically after sphincterotomy; 9 cases′ stones were extracted successfully in one treatment while 2 cases′ stones were extracted secondarily after stents were implanted; 1 case′s stone could not be extracted and need surgical treatment after nasobiliary catheter drainage because of stenosis of the lower part of the common bile duct. There was no dead case in all the cases. Conclusions Acute suppurative cholangitis patients, who have papillary incarcerated stones or inflammatory stenosis, can receive more efficacious diagnosis and treatment by applying PST when routine endoscopic papillary intubation fails. PST is an important endoscopic treatment for acute calculous suppurative cholangitis
ABSTRACT
Objective To review the results of minimally invasive intervention on acute suppurative cholangitis(ASC);the effects of intervention was analyzed.Methods ASC patients had been admitted to our hospital from 2001,6 to 2005,6,and their data was analyzed;35 cases were selected according to the ASC diagnosis criteria,among whom 28 cases were treated by intervention;the data change of WBC and ratio of N before and after treatment were analyzed by T test.Results Twenty-two cases were treated by therapeutic ERCP only;all of them were cured after intervention,among whom 9 cases were drained by therapeutic ERCP for biliary duct obstruction.The effects of 5 cases who suffered from extrohepatic duct obstruction were better than those of 4 cases who suffered from hepatic duct obstruction,but the symptoms of all cases were released after drainage;4 cases were cured by combination of therapeutic ERCP and PTCD;2 cases were treated by PTCD only,among whom one was cured and one was released after treatment.No obvious complication occurred.Conclusion The minimally invasive methods of therapeutic ERCP,PTC and combined therapeutic ERCP and PTCD are good methods for ASC.
ABSTRACT
BACKGROUND/AIMS: Acute suppurative cholangitis is associated with significant mortality. It is best managed by drainage of biliary tree such as endoscopic, percutaneous or surgical, We evaluated the role of emergency endoscopic nasobiliary drainage(ENBD) in the acute suppurative cholangitis. METHODS: For 55 patients with acute calculous cholangitis, who did not respond to conservative management and the stone could not be removed from bile duct by endoscopic papillotomy due to poor condition or bleeding tendency, ENBD tube(7.5Fr) was inserted at proximal side of obstruction. ENBD was done at 39.4 hours (mean) after arrival to hospital. RESULTS: ENBD was successful in all patients (100%). All patients responded with striking improvement of the abdominal pain, fever and stabilized vital signs within 3 days. After patients conditions were stabilized clinically, common bile duct stones were removed successfully by endoscopic sphincterotomy or surgery. No patients died of acute suppurative cholangitis. CONCLUSION: These results show that ENBD is a simple, safe, and effective measure for the initial control of acute suppurative cholangitis due to cholelithiasis.
Subject(s)
Humans , Abdominal Pain , Bile Ducts , Biliary Tract , Cholangitis , Cholelithiasis , Common Bile Duct , Drainage , Emergencies , Fever , Hemorrhage , Mortality , Sphincterotomy, Endoscopic , Strikes, Employee , Vital SignsABSTRACT
The classic clinical manifestations of acute suppurative cholangitis were first described by Charcot in 1877 as a triad of fever(and chill),jaundice and right upper quadrant pain. In 1959,Reynolds and Dargan characterized acute suppurative cholangitis as a distinct clinical entity manifested by a clinical pentad of Charcot,s three signs plus shock and central nervous system depression.We have clinical analysis of acute suppurative cholangitis,218 cases who were admitted in Chonnam Hospital from Jan.1989 to Dec.1995.All cases were treated conservatively initially,and then delayed operation was performed when the patients were improved from the septic condition by cholangitis.