Recurrent pyogenic cholangitis

Background: Recurrent pyogenic cholangitis is a complex biliary tract disease characterized by intrahepatic pigment stones, endemic to Southeast Asia and seen with increasing frequency in the United States. The purpose of this study was to review the management of this disorder in a county hospital. Methods: A retrospective review of 45 patients with recurrent pyogenic cholangitis evaluated between 1984 and 1995. The clinical and surgical management of patients with localized versus bilateral hepatolithiasis were compared. Results: The prevalence of recurrent pyogenic cholangitis at our hospital has more than doubled since 1983. Fourteen of 45 patients (31%) had bilateral disease and required more abdominal computed tomography scans (P<0.01), percutaneous cholangiograms (P<0.05), endoscopies (P<0.01), clinic visits (P<0.05), and hospital admissions (P<0.02) as compared with patients with localized disease. Conclusions: The effective treatment of recurrent pyogenic cholangitis requires definition of the patients’ intrahepatic distribution of disease, prior to surgical intervention, and the coordinated efforts of gastroenterologists, radiologists, and surgeons.