Recurrent Pyogenic Cholangitis

Recurrent pyogenic cholangitis (RPC) 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 Southeast Asia, this disease is now seen worldwide due partly to increased population mobility and international travel. It is characterized by 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 cholangitis causes, diagnosis of RPC is challenging. It requires a multidisciplinary approach, including the emergency physician, gastroenterologist, surgeon, interventional radiologist, and histopathologist, amongst other specialists. This topic seeks to review the etiology, epidemiology, and pathophysiology, outline the evaluation and treatment of pyogenic cholangitis and its potential complications and risks, and highlight the healthcare team's role in managing patients with this condition.