Recurrent Pyogenic Cholangitis (RPC)

A syndrome characterized by

  • – Recurrent bacterial cholangitis
  • – Intrahepatic pigment stone
  • – Biliary Stricture

Possibly leading to chronic liver disease and cholangiocarcinoma

 

Other names of the disease:

  • – Hong Kong disease
  • – Oriental cholangiohepatitis
  • – Hepatolithiasis

Etiology:

Unknown but hypothesis is

  • – Clonorchis sinensis
  • – Opisthorchis viverini
  • – Ascaris lumbricoides
  • * Diet high in carbohydrate but low in fat
  • * Cholecystokinin, a potent mediator of gall bladder contractility is secreted in response to fat
  • * If fat is reduced      Gall bladder stasis       Stone

 

             Clinical features:

  • – Ascending cholangitis
  • – Abdominal pain
  • – Hepatomegaly
  • – Palpable GB
  • – Bilirubin, aminotransferase, leucocyte

            Investigations:

Imaging Study:

  • – Intrahepatic stone
  • – Predominant left hepatic duct
  • Associated GB stone
  • – Dilatation of IHBD
  • – Choledocholithiasis
  • Evaluation for sinensis, Opisthorchis eggs in stool sample
  • Duodenal /Biliary fluid Egg of worms
  • Peripheral eosinophilia

 

                                                                       Treatment of RPC:

  • – ERCP with sphincterotomy with/without nasobiliary drain or percutaneous biliary drainage to remove bile duct stone, traverse stricture
  • – Hepaticojejunostomy
  • – Laparoscopic biliary bypass surgery
  • – Antihelminthic agent : Praziquintal 75 mg/kg in 3 divided dose for 3 days

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