In this study, researchers from Germany present 9 patients with progressive sclerosing cholangitis after septic shock.
All 9 patients had previously required long term treatment in an intensive care unit for septic shock. Of the 9, 2 patients had polytrauma, 5 burn injury, and 2 extensive surgery.
They were admitted to the research team's hospital because of cholangitis.
|4 of the 9 patients rapidly developed liver cirrhosis.|
Endoscopic retrograde cholangiography revealed severe intrahepatic stenoses in all patients. In addition, liver biopsies showed typical signs of sclerosing cholangitis.
The team found that no patient had pre-existing liver disease.
The mean follow up time in this study was 35 months.
The researchers found that in 3 patients with major bile duct stenoses, 12 endoscopic dilations were performed in total.
In 1 patient, concrements were extracted and intermittent stenting required.
The team found that 4 of the 9 patients rapidly developed liver cirrhosis.
During follow up, 5 of the 9 patients died. Of the 5, 5 had fulminant cholangitis, 1 liver failure, 1 liver transplantation associated problems, and 1 cerebral ischemia.
Of the remaining patients, 1 has been registered for transplantation and 3 show no acute signs of liver failure.
Dr Engler's team concluded, "Patients with sclerosing cholangitis, following septic shock, represent a new variant of vanishing bile duct disorders".
"In such patients liver disease rapidly progresses to cirrhosis".
"Endoscopic treatment may only transiently improve the course of the disease".
"Orthotopic liver transplantation is indicated in end stage disease".