LETTERS TO THE EDITOR

Retrospective presentation of 255 episodes of acute cholangitis in our context

Presentación retrospectiva de 255 episodios de colangitis aguda en nuestro medio

Key words: Acute cholangitis. E. Coli. Choledocholithiasis. ERCP. Charcot's triad.

Palabras clave: Colangitis aguda. E. Coli. Coledocolitiasis. CPRE. Tríada de Charcot.

Dear Editor,

Acute cholangitis is a medical syndrome typically characterized by Charcot's triad (fever, jaundice and abdominal pain). The most common cause is biliary obstruction, mainly secondary to lithiasis and related to an infection of the biliary tract due to gram negative bacilli (1). The factors that predict a poor prognosis are tachycardia, hypoalbuminemia, hyperbilirubinemia (> 5 mg/dl), a prothrombin time of more than 14 seconds (2) and leukocytosis with over 20,000 cells/mm (3).

Case report

A retrospective descriptive study was made of hospital episodes of acute cholangitis from 1 January 2002 to 31 December 2007. We recruited 200 patients in all, which represented 255 episodes of acute cholangitis. A study was made of their medical and pathological features, and the origin of their pathology, as well as the treatment they had received.

During that period of time, our hospital admitted 200 patients with a diagnosis of acute cholangitis, of whom 62% were men with an average age of 75 and high number of concurrent disorders. We studied 255 hospital episodes of acute cholangitis, most of which were in the Digestive Surgery. The most frequent reason for the consultation was Charcot's triad. A battery of tests revealed hepatic disorders in the majority of patients (89% hyperbilirubinemia, 87% cytolysis and 87% cholestasis). The main cause of cholangitis was choledocholithiasis (45%), followed by cancer of the liver, pancreas and bile duct (23%). Blood cultures were positive for 45%, with mono-microbial predominance in 80% (the most frequent of which were gram negative bacilli in 91% of the cases). Poly-microbial flora was detected in 19% of the cases, associated with a high mortality rate of 32%. The most frequently employed treatment was drainage of the bile duct by means of ERCP in 48%, followed by medical treatment alone (27%), mixed treatment (12%), transparietohepatic cholangiography 7% and surgery in only 4.7% cases. The preferred antibiotic treatment was β-lactamase in 76.5% of cases. The relapse rate was 16%, with a global mortality rate of 27%.

Discussion

Acute cholangitis is a disorder prevailing in male patients of an advanced average age and with concurrent disorders whose principal manifestation is pain, jaundice and fever, hepatic disorders in batteries of tests and positive blood cultures in close to half of the cases. The most frequent etiology was obstructive (choledocholithiasis). The treatment of choice was drainage of the bile duct by means of ERCP and β-lactamase was the most effective antibiotic treatment. The global mortality rate was 27%, with a group of relapses of up to 36%.

A. B. Díaz Roca, A. Calderón, S. Blanco, P. Ruiz, J. Ortiz de Zárate, F. Menéndez, A. Baranda, M. Bravo, L. Hijona and V. Orive

Service of Digestive Diseases. Hospital de Basurto. Bilbao, Vizcaya. Spain

References

1. Qureshi WA. Approach to the patient who has suspected acute bacterial cholangitis. Gastroenterol Clin N Am 2006; 35: 409-23.        [ Links ]

2. Hui CK, Lai KC, Yuen MF, Ng M, Lai CL, Lam SK. Acute cholangitis. Predictive factors for emergency ERCP. Aliment Pharmacol Ther 2001; 15: 1633-7.        [ Links ]

3. Rosing DK, De Virgilio C, Nguyen AT, El Masry M, Kaji AH, Stabile BE. Cholangitis: analysis of admission prognostic indicators and outcomes. Am Surg 2007; 73(10): 949-54.        [ Links ]