Recurrent Pyogenic Cholangitis

Excerpt

Recurrent pyogenic cholangitis is a condition resulting from repeated infections of the biliary tree (cholangitis) first described in Hong Kong in 1930. It can also be referred to as Oriental cholangiohepatitis, Hong Kong disease, Oriental infestation cholangitis, or hepatolithiasis. Endemic to South East Asia, this disease is now seen worldwide due in part to increased population mobility and international travel. It is characterized by the presence of multiple intraductal calculi causing subsequent biliary tree dilatation and stricture.

Patients typically present with repeating episodes of acute cholangitis and beyond immediate management, are at greater risk of complications than more common types of cholangitis due to the chronicity of the disease. Given its significant overlap in clinical presentation with other causes of cholangitis, diagnosis of recurrent pyogenic cholangitis is challenging. It requires a multidisciplinary approach, including the emergency physician, gastroenterologist, surgeon, interventional radiologist, and histopathology amongst other specialists. This article seeks to review the etiology, epidemiology, pathophysiology, and outline the evaluation and treatment of pyogenic cholangitis and its potential complications and risks, as well as highlight the role of the healthcare team in managing patients with this condition.