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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively; no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.
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PMID:Surgical aspects of sclerosing cholangitis. Results in 178 patients. 222 20

The majority of hepatic abscesses of biliary tract origin are the result of suppurative or non suppurative cholangitis, caused either by common duct stones, inflammatory stricture or malignancies. We report our experience of 7 consecutive liver abscesses after biliary tract surgery, treated in our surgical unit over a 2-year period, there were 6 females and 1 male with an age of 41 to 83 years. Hepatic abscess after biliary surgery developed from 10 days to 14 months postoperatively. Two patients underwent primary surgical drainage and remained clinically well 6 months and 2 years postoperatively. Five patients initially had percutaneous drainage and 4 of them subsequently underwent operative drainage; one patient declined any further operative treatment after percutaneous drainage and died 8 days later from continuing sepsis. Multiple factors may account for the development of both cholangitis and hepatic abscess following biliary tract procedures. Radiologic investigation should not only focus on the abscess itself but must also identify underlying biliary pathology. Our experience suggests that a surgical approach may be preferable to percutaneous techniques as it allows appropriate management of the associated biliary pathology.
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PMID:[Etiology, diagnosis and treatment of hepatic abscesses after biliary tract surgery]. 227 Sep 19

From January 1976 through December 1988 we encountered ninety nine cases of intrahepatic stones. Eight of them were complicated with postoperative bile duct strictures which were formed on cholangiojejunostomy in 5 cases, cholangioduodenostomy, hepatic hilum and common hepatic duct in 1 case, respectively. Six cases of them are anastomotic strictures. The stones were mainly composed of bilirubin calcium. We guessed that the bile duct stricture resulted from cholangiojejunostomy without Roux-en-Y in 1 case and anastomotic insufficiency in 5 cases. Intrahepatic stones were removed by percutaneous transhepatic cholangioscopy (PTCS), and the treatment for the stricture was cholangiojejunostomy in 1 case and the dilatation by PTCS in 5 cases, including 3 endoprostheses by pig-tail silicone catheter and 2 internal-external biliary drainage. Two patients who did not undergo cholangioscopic dilatation died of sepsis due to cholangitis. Three of 5 patients who underwent endoscopic dilatation by PTCS could return to social life without recurrence of gallstones. In other two cases an endoprosthetic catheter was removed by PTCS because of dislodgement or obstruction of the catheter after confirming anastomotic strictures had improved. Authors recommended that PTCS should be applied for postoperative bile duct stricture complicated with intrahepatic stone.
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PMID:[A study on postoperative bile duct stricture with intrahepatic stones]. 227 19

Forty-seven cases of biliary tract infection with septic shock are presented. The sepsis was caused by empyema of the gallbladder in 23 cases and by cholangitis in the remainder. Gallstones were most frequently the cause of the sepsis. An appropriate diagnostic description of the syndrome of biliary tract infection and septic shock should therefore include a description of the underlying biliary disease as well as the term acute biliary shock. In this series, emergency surgical management by removal of gallstones and drainage of suppuration was felt to be the most appropriate treatment. There was a high incidence of gallbladder rupture (10.6%) and intrahepatic stones (53.2%). Of the 13 patients who died, 8 might have survived if early operation had been performed after the diagnosis of acute biliary septic shock was established.
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PMID:Acute biliary septic shock. 227 14

The role of emergency endoscopic nasobiliary drainage (NBD) in the management of severe acute cholangitis was evaluated by comparing the outcome of 15 patients who underwent the procedure as an initial treatment with that of 20 patients who underwent emergency surgery. Biliary sepsis was successfully controlled without complication in all 15 patients by the insertion of a 7F nasobiliary catheter through a limited papillotomy. Subsequent definitive elective treatment included endoscopic stone clearance (n = 6), common duct exploration (n = 8), and bili-enteric reconstruction (n = 1). Among the 20 patients who had surgical treatment, cholecystectomy (n = 11), cholecystostomy (n = 1), and transhepatic intubation (n = 1) were done in addition to common duct exploration. Although patients undergoing endoscopic NBD were significantly older (75.3 years vs 60.1 years; p less than 0.05) and more jaundiced (total bilirubin, 120.3 mmol/L vs 70.4 mmol/L; p less than 0.05), comparable morbidity (40% vs 65%) and mortality (6.7% vs 20%) was observed. Initial endoscopic NBD provides a safe and effective therapeutic option for the management of fulminant biliary sepsis. Among patients with complicated ductal anatomy, endoscopic NBD should first be attempted because, when successful, definitive reconstruction may be performed on an elective basis. The value of its routine application for all patients, however, remains to be validated by further clinical studies.
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PMID:Severe acute cholangitis: the role of emergency nasobiliary drainage. 230 46

The risk of cholangitis after ERCP has been reported to occur in up to 50% of patients with obstructive jaundice. Prophylactic antibiotics have therefore been advocated to reduce the risk. Here we report on the results of 46 patients with obstructive jaundice who were given 1 g of Ceftriaxone i.v. 30 to 60 min. prior to the procedure. Only one patient developed cholangitis with septicemia, which was treated conservatively. No side effects were observed in this group of patients. It is suggested that Ceftriaxone is an adequate prophylactic method to prevent cholangitis and septicemia in patients with obstructive jaundice.
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PMID:[ERCP under ceftriaxone antibiotic cover in patients with obstructive jaundice]. 232 Aug 12

Hereditary hemorrhagic telangiectasia is a rare, hereditary fibrovascular dysplasia. We report a case associated with hepatolithiasis. Hepatolithiasis, relatively common in East Asia, is rare in the West. The association of the two conditions has not been previously reported. In this case, vascular malformations in the liver gave rise to arteriovenous and arterioportal fistulas, causing arteriovenous shunting and protal hypertension, respectively. Abnormal blood flow is the proposed mechanism for the hepatic fibrosis and nodular regeneration. Hepatic fibrosis, by causing stenosis of large intrahepatic bile ducts, bile stasis, and secondary infection, is the hypothesized mechanism for calculus formation. Hepatolithiasis ultimately caused death from acute bacterial cholangitis and septicemia.
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PMID:Hepatolithiasis in hereditary hemorrhagic telangiectasia. 232 2

A retrospective analysis was performed to define the indications and usefulness of computed tomography (CT) in the management of 62 patients with recurrent pyogenic cholangitis. When performed in 18 patients in the acute phase for persistent fever inexplicable by ultrasonography and cholangiography, CT scans identified the cause of sepsis to be liver abscesses (n = 7), impacted stones in left lateral segments (n = 3) and right posterior inferior duct (n = 1). When performed in 44 patients during remission, CT scans detected impacted intrahepatic stones as the cause of non-opacification of segmental bile ducts on cholangiograms (n = 15), demonstrated liver volume changes (segmental atrophy, n = 31; hypertrophy, n = 5), differentiated intrahepatic stones from pneumobilia (n = 5) and revealed stones in segregated intrahepatic bile ducts (n = 4). Overall 75.8% of CT scans showed valuable intrahepatic findings which were useful in guiding the appropriate treatment for the intrahepatic pathology. In the others without demonstrable intrahepatic pathology on CT, patients were adequately treated for common bile duct pathology alone. It is recommended that CT should be performed when ultrasonography and cholangiography cannot elucidate the cause of persistent fever, when the cholangiogram shows non-opacification of segmental bile ducts, or fails to demonstrate the cause of recurrent acute cholangitis, particularly in patients who have had previous bilio-enteric drainage procedures.
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PMID:Role of computed tomography in the management of recurrent pyogenic cholangitis. 239 45

At the instance of a female patient with obstructive jaundice due to inoperable carcinoma of the head of the pancreas is reported on the percutaneous transhepatic cholangiodrainage. With the help of this non-operative palliative drainage of the system of bile ducts in malignant tumors of the biliopancreatic area an at least transitory relief with regression of the jaundice and the excruciating pruritus is achieved. With regard to the relatively high complication rate of the percutaneous drainages performed without laparotomy (haemorrhage, cholangitis, sepsis) and to the possibly already early loss of function by occlusion or dislocation of the catheter the indication for such an approach is strictly to be made.
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PMID:[Percutaneous transhepatic bile duct drainage (PTCD)]. 241 32

Percutaneous biliary drainage was performed in 296 patients on 311 occasions using a fine-needle puncture technique. In 59%, the procedure served as postoperative decompression, and in 35% for palliation of obstruction, particularly in malignant disease. Postoperative drainage for the management of postoperative complication accounted for 2.5%. In more than 80% of the patients treated, the underlying disease was malignant obstructive jaundice. In 257 retrospectively evaluated patients the following complications were observed: cholangitis (6.6%), sepsis (3.1%), bile leakage (1.6%) with two deaths (0.7%), and subcapsular hematoma and hematoma in the hepatoduodenal ligament (1.2%). Catheter dislocations accounted for 8.5% and were eliminated by the use of self-retaining catheters. In 51 prospectively studied patients pain was encountered in 55% and cholangitis in 11.8%. The procedure is most valuable for complicated biliary obstruction, palliative drainage, and endobiliary manipulations.
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PMID:Percutaneous transhepatic biliary drainage: experience with 311 procedures. 245 99


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