Recurrent pyogenic cholangitis (RPC) is a clinical condition caused by repeated episodes of cholangitis, with biliary sepsis secondary to the accumulation of pigmented stones inside the biliary system (see Chapters 39 and 43 ), and there may be associated stricture…
Overview Cholangitis, also called acute cholangitis or ascending cholangitis, occurs when obstructed biliary flow leads to cholestasis and infection of the biliary tree. Cholangitis is commonly caused by choledocholithiasis and a variety of pathologies that obstruct the biliary tree. The…
Overview In this chapter we cover biliary fistulae and strictures from benign etiologies. There is significant overlap in conditions that lead to benign biliary fistulae and strictures, thus these two topics are combined in one chapter. By definition, a biliary…
Overview Primary sclerosing cholangitis (PSC) is a chronic, idiopathic cholangiopathy characterized histologically by peribiliary inflammation and fibrosis. PSC can progress to cirrhosis and is a risk factor for hepatobiliary and colonic carcinogenesis. The median liver transplant (LT) free survival time…
Introduction Extrahepatic biliary atresia or biliary atresia (BA) is an obstructive fibroinflammatory disease that presents in infancy. First described in a case series of 49 patients by John Thompson in 1892, this disease is characterized by a destructive inflammatory cholangiopathy…
Overview Hepatolithiasis (intrahepatic stones) is defined as the presence of gallstones in the bile ducts peripheral to the confluence of the right and left hepatic ducts. These intrahepatic stones can simultaneously be present with stones in the common bile duct…
Diagnostic considerations Imaging modalities: Why and when Determining the presence of cholecystolithiasis and choledocholithiasis can be challenging and often relies on indirect evidence of obstruction. For choledocholithiasis, clinicians use predictive models based on risk factors that include clinical features, abnormal…
Historical overview In the 1970s and 1980s, endoscopic retrograde cholangiopancreatography (ERCP) transformed the diagnostic approach to suspected biliary disease and jaundice (see Chapters 20 and 30 ). Similarly, in the years since it was first performed in humans, , endoscopic…
Introduction Epidemiology of choledocholithiasis The prevalence of cholelithiasis is approximately 15% in the general population, with up to 10% of patients having concomitant choledocholithiasis (CDL; for more information, see Chapter 33 ). The prevalence of gallstones is increased in the…
Overview The first successful common bile duct exploration (CBDE) by Thornton in 1889 and the introduction of catheter-based biliary decompression by Courvoisier and Kehr marked the initial efforts in treating choledocholithiasis. Open cholecystectomy and bile duct exploration were performed commonly…