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.
The common clinical presentation is that of RUQ pain, recurrent fevers and jaundice. Leukocytosis, elevated alkaline phosphatase and bilirubin are seen.
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.
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.
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.
- 1. Park MS, Yu JS, Kim KW et-al. Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography. Radiology. 2001;220 (3): 677-82. doi:10.1148/radiol.2202001252 - Pubmed citation
- 2. Kim MJ, Cha SW, Mitchell DG et-al. MR imaging findings in recurrent pyogenic cholangitis. AJR Am J Roentgenol. 1999;173 (6): 1545-9. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Cosenza CA, Durazo F, Stain SC et-al. Current management of recurrent pyogenic cholangitis. Am Surg. 1999;65 (10): 939-43. - Pubmed citation
- 4. Vansonnenberg E, Casola G, Cubberley DA et-al. Oriental cholangiohepatitis: diagnostic imaging and interventional management. AJR Am J Roentgenol. 1986;146 (2): 327-31. AJR Am J Roentgenol (abstract) - Pubmed citation
- 5. Lim JH. Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol. 1991;157 (1): 1-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 6. Goldberg HI, Gordon R. Diagnostic and interventional procedures for the biliary tract. Curr Opin Radiol. 1991;3 (3): 453-62. - Pubmed citation
- 7. Kusano S, Okada Y, Endo T et-al. Oriental cholangiohepatitis: correlation between portal vein occlusion and hepatic atrophy. AJR Am J Roentgenol. 1992;158 (5): 1011-4. AJR Am J Roentgenol (abstract) - Pubmed citation
- 8. Federle MP, Cello JP, Laing FC et-al. Recurrent pyogenic cholangitis in Asian immigrants. Use of ultrasonography, computed tomography, and cholangiography. Radiology. 1982;143 (1): 151-6. Radiology (abstract) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Recurrent pyogenic cholangitis||✗|
|Recurrent pyogenic cholangiohepatitis||✓|