Dr Ozden and colleagues noted that iatrogenic factors had become the leading mechanisms of severe cholangitis in a referral center in Turkey.
| Incomplete biliary drainage due to advanced tumors or technical failure caused mortality in 8 patients|
|American Journal of Surgery|
The researchers therefore evaluated the records of 58 patients treated for severe cholangitis between 1996 and 2004.
The research team found that the most frequent underlying diseases were periampullary tumors, and mid-bile duct carcinomas in 22 patients.
The team observed that proximal cholangiocarcinomas occurred in 14 patients.
The researchers noted that the triggering mechanism included an incomplete endoscopic retrograde cholangiopancreatography in 32 patients, and incomplete or inappropriate percutaneous transhepatic biliary drainage in 6.
Other triggering mechanisms identified were apparently successful endoscopic retrograde cholangiopancreatography and stenting in 1, and percutaneous transhepatic cholangiography in 1.
The team reported that percutaneous transhepatic cholangiography was the treatment of choice by 38 patients.
The investigative team observed that mortality was 29%.
The major causes for mortality were refractory sepsis in 8 patients, and incomplete biliary drainage in 8 patients that were caused by advanced tumors, technical failure, or hemobilia.
Dr Ozden's team concludes, “This series composed predominantly of patients referred after development of sepsis.”
“Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography complications were the leading mechanisms of severe cholangitis.”
“Nonoperative biliary manipulations are invasive procedures with potentially fatal complications.”
“The decisions to perform such procedures and periprocedural management are responsibilities of an experienced multidisciplinary team.”