Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass
J. B. Matthews, H. U. Baer, W. P. Schweizer, P. Gertsch, T. Carrel and L. H. Blumgart
Department of Surgery, Beth Israel Hospital, Boston, MA 02215.
We recently surgically treated 24 patients incapacitated by recurrent
cholangitis after biliary-enteric anastomosis performed for benign disease.
Contrary to commonly held dogma, as many as one third of the patients had
no evidence of anastomotic stricture indicated by radiologic and operative
findings. We identified several other primary and coexistent pathogenetic
factors including intrahepatic stricture in 42% of the patients,
intrahepatic calculi in 25%, improperly constructed enteric conduits in
13%, and conditions that predispose to bacterial overgrowth in the biliary
tree in 17%. Seventy-one percent of the patients had multiple etiologic
factors, and of those patients without demonstrable anastomotic stricture,
intrahepatic stricture was particularly common. Seventy-one percent
remained symptom-free in their first year after operation. The most
difficult situation to manage, and the factor responsible for most
recurrences after our reoperation, involved intrahepatic stricture. A
combined surgical and interventional radiologic approach to complex cases
may be useful in selected patients.
