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  Vol. 130 No. 5, May 1995 TABLE OF CONTENTS
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Surgical treatment of recurrent pyogenic cholangitis

S. C. Stain, R. Incarbone, C. R. Guthrie, P. W. Ralls, S. Rivera-Lara, D. Parekh and A. E. Yellin
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.

OBJECTIVE: To examine the evolving operative strategies in the treatment of recurrent pyogenic cholangitis (RPC). DESIGN: Case series of patients with RPC treated surgically at the Los Angeles County-University of Southern California Medical Center between 1980 and 1994. SETTING: Public teaching hospital. PATIENTS: Twenty patients with RPC were studied. The clinical diagnosis of RPC was made in patients with a syndrome of chronic intermittent attacks of biliary sepsis associated with intrahepatic biliary strictures and intrahepatic stones. MAIN OUTCOME MEASURE: The need for repeated biliary intervention after surgical treatment of RPC. RESULTS: Four patients had a hepatic lobectomy without biliary enteric bypass. One patient had an uneventful course. Three patients had postoperative biliary sepsis, and one of these patients died. A hepaticojejunostomy without a cutaneous stoma was performed in eight patients. Five (63%) of these eight required repeated operation for biliary sepsis 1 to 4 years after surgery. In eight patients, a Roux-en-Y hepaticojejunostomy was performed after attempted clearance of intrahepatic stones with construction of a temporary cutaneous stoma. Postoperatively, these eight patients had 16 transstomal endoscopic cholangiograms (mean follow-up, 10 months). Stones proximal to intrahepatic strictures were identified in seven endoscopic sessions in five of these patients (63%). The stones were removed, and the strictures were endoscopically dilated. None required repeated biliary operation. CONCLUSION: RPC is a progressive, lifelong disease. Construction of a hepaticojejunostomy with a cutaneous stoma allows future therapeutic intervention without the need for repeated surgery.

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CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis.
Park et al.
Am. J. Roentgenol. 2006;187:445-453.
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