Oriental cholangiohepatitis (or recurrent pyogenic cholangiohepatitis) is a condition essentially found in Southeast Asia and is characterised by intra- and extrahepatic bile duct strictures and dilatation with intraductal pigmented stone formation. Diagnosis is made after exclusion of more common conditions such as biliary stricture of known cause like previous surgery, trauma etc, primary or secondary sclerosing cholangitis and cholangiocarcinoma.
The common clinical presentation is that of recurrent RUQ pain, fever and jaundice. Leukocytosis with elevated alkaline phosphatase and bilirubin are seen.
The exact aetiology is not well understood but strongly association with hepatobiliary infestation with Clonorchis sinensis (liver fluke) (see: clonorchiasis) or ascaris lumbricoides have been implicated. Other associations include poor nutritional or socioeconomic status and ascending cholangitis from gut Escherichia coli flora.
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 stricture which could ultimately leads into focal liver fibrosis or diffuse biliary cirrhosis.
MRCP is superior to ERCP in depicting intra- and extrahepatic changes.
The best diagnostic clues are intra- and extrahepatic biliary dilatation and multilevel strictures with intraductal pigmented calculi usually in the absence of gallbladder calculi, combination of variable density calculi/sludge and regions of segmental liver atrophy (particularly lateral aspect of the left hepatic lobe) secondary to chronic biliary obstruction.
- stones are usually hyperdense to the liver parenchyma
- focal areas of fibrosis with heterogenous enhancement and focal steatosis
- reduced arborization of peripheral ducts "arrowhead sign"
- multiple intra- and extrahepatic biliary strictures
Treatment and prognosis
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
- 9. Katabathina VS, Dasyam AK, Dasyam N et-al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 2014;34 (3): 565-86. doi:10.1148/rg.343125211 - Pubmed citation
- 10. Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. Elsevier Health Sciences. (2015) ISBN:0323278116. Read it at Google Books - Find it at Amazon
- 11. Wani NA, Robbani I, Kosar T. MRI of oriental cholangiohepatitis. Clin Radiol. 2011;66 (2): 158-63. doi:10.1016/j.crad.2010.06.017 - Pubmed citation