Recurrent pyogenic cholangitis

Case contributed by Dr Charudutt Jayant Sambhaji

Presentation

Jaundice.

Patient Data

Age: 30 years old
Gender: Male
CT

CT Intravenous Cholangiogram

Intrahepatic biliary tree dilatation, more in the left lobe than the right. The supraduodenal common bile duct (CBD) shows wall thickening and smooth narrowing. Segment 8 of the liver shows relative atrophy and multiple dense intraductal calculi. Low density calculi and sludge was also noted in the CBD. No gallbladder calculi were seen.

Fluoroscopy

ERCP

ERCP failed to negotiate the strictures.

Percutaneous transhepatic cholangiography (PTC)

Multiple intrahepatic tight strictures.

Case Discussion

Brush biopsy was negative for malignancy. By exclusion, a diagnosis of recurrent pyogenic cholangitis was made. A right external and a left internal external percutaneous biliary drainage was placed with relief of symptoms. 

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

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

The condition is usually associated with poor nutritional status and biliary parasitic infestation by Clonorchis sinensis and/or Ascaris lumbricoides and is primarily seen in Southeast Asians.

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Case information

rID: 5782
Published: 22nd Mar 2009
Last edited: 18th Nov 2018
Inclusion in quiz mode: Included

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