Acute cholangitis secondary to hepatolithiasis
S. T. Fan, E. C. Lai, F. P. Mok, T. K. Choi and J. Wong
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
In a series of 88 patients with acute cholangitis secondary to
hepatolithiasis, 26 (30%) required emergency therapeutic intervention
because of septicemic shock (n = 15), persistent fever (n = 8), or
spreading peritonitis (n = 3). Analysis was made to define factors that
predisposed to failure of conservative treatment and characteristics that
could predict the need for emergency biliary decompression. The age,
incidence of concomitant medical diseases, previous biliary surgery,
positive blood culture, bacterial strains resistant to antibiotics used,
and multiplicity of bacterial strains in bile cultures in patients who
required emergency intervention were similar to these factors in patients
who had elective operations after successful conservative management. The
incidence of intrahepatic segmental obstruction by stones or strictures was
similar, but many more patients who required emergency intervention had
concomitant extrahepatic obstruction due to impacted common ductal stones
or strictures. Logistic regression analysis of clinical, hematological, and
biochemical data showed that maximum pulse rate within 24 hours of
presentation (greater than 100 beats per minute, relative risk, 2.8) and
platelet count at the time of admission (less than 150 x 10(9)/L, relative
risk, 5.2) were the factors with independent significance in predicting the
need for emergency therapeutic procedures. This finding may serve as a
guideline for identifying high-risk patients for early intervention.
