Q) Which statement is not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledocho duodenal fistula
c) There is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
Answer c
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked.
RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes. ( Sabiston 21st edition page 1461)
Cause for recurrent pyogenic cholangitis
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
Stones and strictures
Clinical Presentation of Recurrent pyogenic Cholangitis
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
Radiology for Recurrent Pyogenic Cholangitis
MRCP can be diagnostic and is preferred because of its non invasive nature.
Surgical treatment
Goal is to clear the biliary tree and to bypass or resect the strictures
