Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines

Yasutoshi Kimura, Tadahiro Takada, Yoshifumi Kawarada, Yuji Nimura, Koichi Hirata, Miho Sekimoto, Masahiro Yoshida, Toshihiko Mayumi, Keita Wada, Fumihiko Miura, Hideki Yasuda, Yuichi Yamashita, Masato Nagino, Masahiko Hirota, Atsushi Tanaka, Toshio Tsuyuguchi, Steven M Strasberg, Thomas R Gadacz, Yasutoshi Kimura, Tadahiro Takada, Yoshifumi Kawarada, Yuji Nimura, Koichi Hirata, Miho Sekimoto, Masahiro Yoshida, Toshihiko Mayumi, Keita Wada, Fumihiko Miura, Hideki Yasuda, Yuichi Yamashita, Masato Nagino, Masahiko Hirota, Atsushi Tanaka, Toshio Tsuyuguchi, Steven M Strasberg, Thomas R Gadacz

Abstract

This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.

References

    1. Lai EC, Tam PC, Paterson IA, Ng MM, Fan ST, Choi TK, et al. Emergency surgery for severe acute cholangitis. The high-risk patients. Ann Surg. 1990;211:55–9. doi: 10.1097/00000658-199001000-00009.
    1. Charcot M. Comparison avec la fievre uroseptique. Lecons sur les maladies du foie des voies biliares et des reins. Paris: Bourneville et Sevestre; 1877. De la fievre hepatique symptomatique; pp. 176–85.
    1. Reynolds BM, Dargan EL. Acute obstructive cholangitis. A distinct syndrome. Ann Surg. 1959;150:299–303. doi: 10.1097/00000658-195908000-00013.
    1. Longmire WP. Suppurative cholangitis. In: Hardy JD, editor. Critical surgical illness. New York: Saunders; 1971. pp. 397–424.
    1. Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am. 1990;70:1297–312.
    1. Gigot JF, Leese T, Dereme T, Coutinho J, Castaing D, Bismuth H. Acute cholangitis: multivariate analysis of risk factors. Ann Surg. 1989;209:435–8. doi: 10.1097/00000658-198904000-00008.
    1. Saharia PC, Cameron JL. Clinical management of acute cholangitis. Surg Gynecol Obstet. 1976;142:369–72.
    1. Pitt HA, Couse NF. Biliary sepsis and toxic cholangitis. In: Moody FG, Carey LC, editors. Surgical treatment of digestive diseases. ed 2. Chicago: Year Book Medical; 1990. p. 332.
    1. Thompson JE, Jr, Pitt HA, Doty JE, Coleman J, Irving C. Broad spectrum penicillin as an adequate therapy for acute cholangitis. Surg Gynecol Obstet. 1990;171:275–82.
    1. Basoli A, Schietroma M, De Santis A, Colella A, Fiocca F, Speranza V. Acute cholangitis: diagnostic and therapeutic problems. Ital J Surg Sci. 1986;16:261–7.
    1. Daida A, Miki M, Yoshioka M, Moriyama Y. Collective study results on the bacteriological examination during biliary surgery (in Japanese) Jpn J Gastroenterol Surg. 1980;13:445–9.
    1. Edlund YA, Mollsted BO, Ougchterlony O. Bacteriological investigation of the biliary system and liver in biliary tract disease correlated to clinical data and microstructure of the gallbladder and liver. Acta Chir Scand. 1959;116:461–76.
    1. Keighley MR, Lister DM, Jacobs SI, Giles GR. Hazards of surgical treatment due to microorganisms in the bile. Surgery. 1974;75:578–83.
    1. Sinanan MN. Acute cholangitis. Infect Dis Clin North Am. 1992;6:571–99.
    1. Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari AP, Jr, Montes H, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc. 2002;56:652–6. doi: 10.1016/S0016-5107(02)70112-0.
    1. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18. doi: 10.1056/NEJM199609263351301.
    1. Lenriot JP, Le Neel JC, Hay JM, Jaeck D, Millat B, Fagniez PL. Catheteisme retrograde et sphincterotomie endoscopique. Evaluation prospective en milieu chirurgical. Gastroenterol Clin Biol. 1993;17:244–50.
    1. Benchimol D, Bernard JL, Mouroux J, Dumas R, Elkaim D, Chazal M, et al. Infectious complications of endoscopic retrograde cholangio-pancreatography managed in a surgical unit. Int Surg. 1992;77:270–3.
    1. Cotton PB, Lehman G, Vennes JA, Geenen JE, Russell RCG, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:255–8.
    1. Reiertsen O, Skjoto J, Jacobsen CD, Rosseland AR. Complications of fiberoptic gastrointestinal endoscopy; 5 years’ experience in a central hospital. Endoscopy. 1987;19:1–6. doi: 10.1055/s-2007-1013011.
    1. Roszler MH, Campbell WL. Post-ERCP pancreatitis: association with urographic visualization during ERCP. Radiology. 1985;157:595–8.
    1. Escourrou J, Cordova JA, Lazorthes F, Frexinos J, Ribet A. Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder “in situ”. Gut. 1984;25:598–602. doi: 10.1136/gut.25.6.598.
    1. Bilbao MK, Dotter CT, Lee TG, Katon RM. Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10000 cases. Gastroenterology. 1976;70:314–20.
    1. McSherry CK, Ferstenberg H, Virshup M. The Mirizzi syndrome: suggested classification and surgical therapy. Surg Gastroenterol. 1982;1:219–25.
    1. Lemmel G. Die kliniscle Bedeutung der Duodenal Divertikel. Arch Venduungskrht. 1934;46:59–70. doi: 10.1159/000196978.
    1. Andrew DJ, Johnson SE. Acute suppurative cholangitis, a medical and surgical emergency. A review of 10 years. Am J Gastroenterol. 1970;54:141–54.
    1. Shimada H, Nakagawara G, Kobayashi M, Tsuchiya S, Kudo T, Morita S. Pathogenesis and clinical features of acute cholangitis accompanied by shock. Jpn J Surg. 1984;14:269–77. doi: 10.1007/BF02469641.
    1. Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis. Br J Surg. 1992;79:655–8. doi: 10.1002/bjs.1800790720.
    1. Himal HS, Lindsay T. Ascending cholangitis: surgery versus endoscopic or percutaneous drainage. Surgery. 1990;108:629–33.
    1. Chijiiwa K, Kozaki N, Naito T, Kameoka N. Treatment of choice for choledocholithiasis in patients with acute obstructive suppurative cholangitis and liver cirrhosis. Am J Surg. 1995;170:356–60. doi: 10.1016/S0002-9610(99)80303-1.
    1. Liu TJ. Acute biliary septic shock. HPB Surg. 1990;2:177–83. doi: 10.1155/1990/71059.
    1. Lai EC, Tam PC, Paterson IA, Ng MM, Fan ST, Choi TK, et al. Emergency surgery for severe acute cholangitis. The high risk patients. Ann Surg. 1990;211:55–9. doi: 10.1097/00000658-199001000-00009.
    1. Thompson JE, Jr, Pitt HA, Doty JE, Coleman J, Irving C. Broad spectrum penicillin as an adequate therapy for acute cholangitis. Surg Gynecol Obstet. 1990;171:275–82.
    1. Arima N, Uchiya T, Hishikawa R, Saito M, Matsuo T, Kurisu S, et al. Clinical characteristics of impacted bile duct stone in eldely (in Japanese) Jpn J Geriatr. 1993;30:964–8.
    1. Kunisaki C, Kobayashi S, Kido Y, Imai S, Harada H, Moriwaki Y, et al. Clinical evaluation of acute cholangitis — with speciaal reference to detection of prognostic factor for acute obstructive suppurative cholangitis (in Japanese) J Abd Emerg Med. 1997;17:261–6.
    1. Tai DI, Shen FH, Liaw YF. Abnormal pre-drainage serum creatinine as a prognostic indicator in acute cholangitis. Hepatogastroenterology. 1992;39:47–50.
    1. Thompson J, Bennion RS, Pitt HA. An analysis of infectious failures in acute cholangitis. HPB Surg. 1994;8:139–45. doi: 10.1155/1994/73139.
    1. Eskelinen M, Ikonen J, Lipponen P. Diagnostic approaches in acute cholecystitis; a prospective study of 1333 patients with acute abdominal pain. Theor Surg. 1993;8:15–20.
    1. Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL. Abdominal pain. An analysis of 1000 consecutive cases in a University Hospital emergency room. Am J Surg. 1976;131:219–23. doi: 10.1016/0002-9610(76)90101-X.
    1. Telfer S, Fenyo G, Holt PR, de Dombal FT. Acute abdominal pain in patients over 50 years of age. Scand J Gastroenterol. 1988;144:S47–50.
    1. Gouma DJ, Obertop H. Acute calculous cholecystitis. What is new in diagnosis and therapy? HPB Surg. 1992;6:69–78. doi: 10.1155/1992/46529.
    1. Mack E. Role of surgery in the management of gallstones. Semin Liver Dis. 1990;10:222–31. doi: 10.1055/s-2008-1040477.
    1. Hermann RE. Surgery for acute and chronic cholecystitis. Surg Clin North Am. 1990;70:1263–75.
    1. Sharp KW. Acute cholecystitis. Surg Clin North Am. 1988;68:269–79.
    1. Williamson RC. Acalculous disease of the gall bladder. Gut. 1988;29:860–72. doi: 10.1136/gut.29.6.860.
    1. Barie PS, Fischer E. Acute acalculous cholecystitis. J Am Coll Surg. 1995;180:232–44.
    1. Reiss R, Deutsch AA. State of the art in the diagnosis and management of acute cholecystitis. Dig Dis. 1993;11:55–64. doi: 10.1159/000171401.
    1. Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993;165:399–404. doi: 10.1016/S0002-9610(05)80930-4.
    1. Persson GE. Expectant management of patients with gallbladder stones diagnosed at planned investigation. A prospective 5- to 7-year follow-up study of 153 patients. Scand J Gastroenterol. 1996;31:191–9. doi: 10.3109/00365529609031985.
    1. Glambek I, Arnesjo B, Soreide O. Correlation between gallstones and abdominal symptoms in a random population. Results from a screening study. Scand J Gastroenterol. 1989;24:277–81. doi: 10.3109/00365528909093046.
    1. Cello JP. AIDS-Related biliary tract disease. Gastrointest Endosc Clin North Am. 1998;8:963.
    1. LaRaja RD, Rothenberg RE, Odom JW, Mueller SC. The incidence of intra-abdominal surgery in acquired immunodeficiency syndrome: a statistical review of 904 patients. Surgery. 1989;105:175–9.
    1. Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease. Incidence, aetiology and management. Drug Saf. 1992;7:32–45. doi: 10.2165/00002018-199207010-00005.
    1. Royal College of General Practitioners’ oral contraception study Oral contraceptives and gallbladder disease. Lancet. 1982;II:957–9.
    1. Cooper J, Geizerova H, Oliver MF. Clofibrate and gallstones. Lancet. 1975;I:1083. doi: 10.1016/S0140-6736(75)91845-0.
    1. Rosenberg L, Shapiro S, Slone D, Kaufman DW, Miettinen OS, Stolley PD. Thiazides and acute cholecystitis. N Engl J Med. 1980;303:546–8.
    1. Porter JB, Jick H, Dinan BJ. Acute cholecystitis and thiazides. N Engl J Med. 1981;304:954–5.
    1. Nelson HD, Humphrey LL, Nygren P, Teutsch SM, Allan JD. Postmenopausal hormone replacement therapy: scientific review. JAMA. 2002;288:872–81. doi: 10.1001/jama.288.7.872.
    1. Khuroo MS. Ascariasis. Gastroenterol Clin North Am. 1996;25:553–77. doi: 10.1016/S0889-8553(05)70263-6.
    1. Sharp HT. The acute abdomen during pregnancy. Clin Obstet Gynecol. 2002;45:405–13. doi: 10.1097/00003081-200206000-00011.
    1. Barone JE, Bears S, Chen S, Tsai J, Russell JC. Outcome study of cholecystectomy during pregnancy. Am J Surg. 1999;177:232–6. doi: 10.1016/S0002-9610(99)00007-0.
    1. Friedman GD, Kannel WB, Dawber TR. The epidemiology of gallbladder disease: observations in the Framingham Study. J Chronic Dis. 1966;19:273–92. doi: 10.1016/0021-9681(66)90132-9.
    1. Gutman H, Sternberg A, Deutsch AA, Haddad M, Reiss R. Age profiles of benign gallbladder disease in 2000 patients. Int Surg. 1987;72:30–3.
    1. Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000;12:1347–52. doi: 10.1097/00042737-200012120-00015.
    1. Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989;149:1750–3. doi: 10.1001/archinte.149.8.1750.
    1. Everhart JE. Contributions of obesity and weight loss to gallstone disease. Ann Intern Med. 1993;119:1029–35.
    1. Mun EC, Blackburn GL, Matthews JB. Current status of medical and surgical therapy for obesity. Gastroenterol. 2001;120:669–81. doi: 10.1053/gast.2001.22430.
    1. Torgerson JS, Lindroos AK, Naslund I, Peltonen M. Gallstones, gallbladder disease, and pancreatitis: cross-sectional and 2-year data from the Swedish Obese Subjects (SOS) and SOS reference studies. Am J Gastroenterol. 2003;98:1032–41.
    1. Gross RE. Congenital anomalies of the gallbladder. Arch Surg. 1936;32:131–62.
    1. Hunt DR, Chu FC. Gangrenous cholecystitis in the laparoscopic era. Aust N Z J Surg. 2000;70:428–30. doi: 10.1046/j.1440-1622.2000.01851.x.
    1. Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, et al. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery. 1999;126:680–5.
    1. Wilson AK, Kozol RA, Salwen WA, Ma LJ, Tennenberg SD. Gangrenous cholecystitis in an urban VA hospital. J Surg Res. 1994;56:402–4. doi: 10.1006/jsre.1994.1064.
    1. Bedirli A, Sakrak O, Sozuer EM, Kerek M, Guler I. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology. 2001;48:1275–8.
    1. Tokunaga Y, Nakayama N, Ishikawa Y, Nishitai R, Irie A, Kaganoi J, et al. Surgical risks of acute cholecystitis in elderly. Hepatogastroenterology. 1997;44:671–6.
    1. Ransohoff DF, Miller GL, Forsythe SB, Hermann RE. Outcome of acute cholecystitis in patients with diabetes mellitus. Ann Intern Med. 1987;106:829–32.
    1. Meyer KA, Capos NJ, Mittelpunkt AI. Personal experiences with 1261 cases of acute and chronic cholecystitis and cholelithiasis. Surgery. 1967;61:661–8.
    1. Gagic N, Frey CF, Galness R. Acute cholecystitis. Surg Gynecol Obstet. 1975;140:868–74.
    1. Girard RM, Morin M. Open cholecystectomy: its morbidity and mortality as a reference standard. Can J Surg. 1993;36:75–80.
    1. Addison NV, Finan PJ. Urgent and early cholecystectomy for acute gallbladder disease. Br J Surg. 1988;75:141–3. doi: 10.1002/bjs.1800750217.
    1. Bedirli A, Sakrak O, Sozuer EM, Kerek M, Guler I. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterol. 2001;48:1275–8.
    1. Gharaibeh KI, Qasaimeh GR, Al-Heiss H, Ammari F, Bani-Hani K, Al-Jaberi TM, et al. Effects of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech. 2002;12:193–8. doi: 10.1089/10926420260188092.
    1. Kalliafas S, Ziegler DW, Flancbaum L, Choban PS. Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. Am Surgeon. 1998;64:471–5.
    1. Inoue T, Mishima Y. Postoperative acute cholecystitis: a collective review of 494 cases in Japan. Jpn J Surg. 1988;18:35–42. doi: 10.1007/BF02470844.
    1. Savoca PE, Longo WE, Zucker KA, McMillen MM, Modlin IM. The increasing prevalence of acalculous cholecystitis in outpatients. Results of a 7-year study. Ann Surg. 1990;211:433–7. doi: 10.1097/00000658-199004000-00009.
    1. Hafif A, Gutman M, Kaplan O, Winkler E, Rozin RR, Skornick Y. The management of acute cholecystitis in elderly patients. Am Surgeon. 1991;57:648–52.
    1. Glenn F. Surgical management of acute cholecystitis in patients 65 years of age and older. Ann Surg. 1981;193:56–9.
    1. Gingrich RA, Awe WC, Boyden AM, Peterson CG. Cholecystectomy in acute cholecystitis. Factors influencing morbidity and mortality. Am J Surg. 1968;116:310–5. doi: 10.1016/0002-9610(68)90509-6.
    1. Andren-Sandberg A, Haugsvedt T, Larssen TB, Sondenaa K. Complication and late outcome following percutaneous drainage of the gallbladder in acute calculous cholecystitis. Dig Surg. 2001;18:393–8. doi: 10.1159/000050180.
    1. Granlund A, Karlson BM, Elvin A, Rasmussen I. Ultrasound-guided percutaneous cholecystectomy in high-risk surgical patients. Langenbecks Arch Surg. 2001;386:212–7. doi: 10.1007/s004230100211.
    1. Lahtinen J, Alhava EM, Aukee S. Acute cholecystitis treated by early and delayed surgery. A controlled clinical trial. Scand J Gastroenterol. 1978;13:673–8.
    1. Sondenaa K, Nesvik I, Solhaug JH, Soreide O. Randomization to surgery or observation in patients with symptomatic gallbladder stone disease. The problem of evidence-based medicine in clinical practice. Scand J Gastroenterol. 1997;32:611–6. doi: 10.3109/00365529709025108.
    1. McLoughlin RF, Patterson EJ, Mathieson JR, Cooperberg PL, MacFarlane JK. Radiologically guided percutaneous cholecystectomy for acute cholecystitis: long-term outcome in 50 patients. Can Assoc Radiol J. 1994;45:455–9.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する