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Oriental cholangiohepatitis

Oriental cholangiohepatitis (or recurrent pyogenic cholangiohepatitis) is a condition essentially found in south east Asia and is caused by hepatobilliary infestation with Chlonorchis sinensis (liver fluke) (see: clonorchiasis). Although other organisms have also been implicated:

It is a diagnosis made after exclusion of the common differential diagnosis for this condition, that include Intrahepatic stones secondary to biliary stricture of known cause like previous surgery, trauma etc., sclerosing cholangitis and cholangiocarcinoma.

The condition is usually associated with poor nutritional status.

Clinical presentation

The common clinical presentation is that of RUQ pain, recurrent fevers and  jaundice. Leukocytosis, elevated alkaline phosphatase and bilirubin are seen.

Pathology

The fluke acts like a nidus for stone formation and either directly or by causing strictures aids which to their formation.

Periductal inflammatory changes with infiltration of periportal spaces with inflammatory cells leading to periductal fibrosis and ultimately biliary cirrhosis are the histopathological findings.

Radiographic features

The best diagnostic clues are intra- and extra-hepatic biliary dilatation due to multilevel strictures and calculi within them without gall bladder calculi, combination of variable density calculi / sludge and regions of segmental liver atrophy secondary to chronic biliary obstruction.

Management

Interventional radiology plays a role in percutaneous biliary drainage of affected segments, removal of pigment stones, balloon dilation of biliary strictures and  repeated percutaneous procedures to clear pigment stones and mud-like biliary debris. 

Complications

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