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Emergency bile duct decompression by endoscopic cannulation in acute obstructive suppurative cholangitis



Emergency bile duct decompression by endoscopic cannulation in acute obstructive suppurative cholangitis



Stomach & Intestine (Tokyo) 17(11): 1213-1222



The high mortality rate reported in previous series of acute obstructive supprative cholangitis (AOSC) suggests the need for a quicker and less invasive method for bile duct decompression. Duodenoscopic cannulation is a rather simple yet life-saving procedure in this respect. Twenty patients suspected of having AOSC were treated by emergency bile duct cannulation. All patients presented with abdominal pain, fever and jaundice. Twelve of these had true AOSC, judging from their clinical pictures and the purulent nature of bile, while the others had acute obstructive cholangitis. Four of the 12 patients with AOSC were in profound shock, including 3 with mental symptoms. The patients' papillae were cannulated and impacted stones were removed with instant and dramatic relief of all the symptoms. Since no sufficient information as to the number and size of the stones or ductal anatomy is available in most cases in such an emergency state or since AOSC may be associated with coagulation deficits, one should not insist on performing sphincterotomy and/or basket extraction; rather, bile duct decompression alone must be performed with no delay.

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Accession: 005354113

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