J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 1009KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 83(11): 1321-1330, 1982

Original article

THE PATHOENESIS AND CLINICAL FEATURE OF ACUTE CHOLANGITIS ACCOMPANIED BY SHOCK

1) The First Department of Surgery, Fukui Medical School
2) The Second Department of Surgery, School of Medicine, Yokohama City University
3) The Department of Surgery, Yokohama Red Cross Hospital

Hiroshi Shimada1), Fumihiko Kito2), Tetsuo Abe2), Mamoru Kobayashi2), Koichiro Shinnyo2), Shuji Tsuchija2), Takuja Kudo3), Shuhei Morita3)

91 acute cholangitis patients comprising 42 with shock (severe group) and 49 without shock (mild group) were investigated. The incidence of endotoxemia was 78.6％ in severe group and 32.6％ in mild group. Endotoxemia were probably derived from the infected bile, because gram-negative bacteria detected in blood were the same in the bile of each patients. The mechanism in occurrence of endotoxemia was the cholangiovenous reflux produced by the elevation of bile duct pressure and the direct infection of liver abscess originated by cholangitis. Remarkable leukocytosis, thrombocytopenia, decrease of serum CH50, C3, plasma fibronectin and hepatic phagocytic function (iron load test) were characteristic in severe group. DIC was observed in 76.2％ of severe group, pulmonary insufficiency in 52.4％, renal failure in 50.0％. There was no difference in mortality between nonsurgical treatment (lethality: 57.8％) and the emergency bile drainage (lethality: 56.5％). Therapeutic results were affected by the degree of complicating DIC and the organ failure. We concluded that acute cholangitis was aggravated by endotoxemia and severe cholangitis with shock was accompanied DIC and organ failure.

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