J.Jpn. Surg. Soc.. 81(8): 766-781, 1980
Original article
CLINICAL AND EXPERIMENTAL STUDIES ON ACUTE OBSTRUCTIVE SUPPURATIVE CHOLANGITIS WITH SPECIAL REFERENCE TO HEPATIC HEMODYNAMICS
|
The First Department of Surgery, Nippon Medical School, Tokyo (Director: Prof. Akiro Shirota) Kenji Yamaguchi |
Method: 1) Clinically 18 cases (male 11, female 7) of this disease were evaluated. 2) The experiments were performed in dogs weighing 15-31 kg, and rabbits weighing 2.5—3.0 kg respectively. E. coli 0-26 or its endotoxin was injected into the common bile duct at intervals of a week, two weeks etc. after ligation of the common bile duct. Injection was accompanied with the measurement of the hepato-renal hemodynamics, specifically portal vein, hepatic artery and renal artery flow using the electro-magnetic flow meter.
Results: 1) Twelve cases out of 18 cases with this disease belonged to over 60 years old in age. Seven cases had undergone surgery for cholelithiasis previously. Charcot's triad were observed in all cases. Shock was seen in 15 cases, disturbance of consciousness in 13 cases and oliguria in 11 cases. All of 13 cases of culture of bile, 2 cases out of 8 on culture of blood yielded bacteria respectively. Two cases were positive on limulus test. Biliary obstruction were caused by gallstone in 14 cases. From autopsy findings of 11 cases, liver abscess was observed in 10 cases and shock kidney in 7 cases. 2) Even in the control animals, as well as with experimental obstructive jaundice, the remarkable decrease of hepatic hemodynamics causing shock were observed with an artificial increase of bile duct pressure up to 450 mmH2O following the injection of E. coli 0-26 or endotoxin into the common bile duct and also endotoxin was noticed in blood by Limulus test.
Conclusion: Endotoxemia in subjected disease would be caused by cholangio-venous reflux or shunt. A biliary tract surgery, therefore, should be performed without excessive increase of bile duct pressure.
To read the PDF file you will need Adobe Reader installed on your computer.