Grier J F, Cohen S W, Grafton W D, Gholson C F
Department of Medicine, Louisiana State University School of Medicine, Shreveport.
Am J Gastroenterol. 1994 Apr;89(4):617-9.
Three patients with acute cholangitis who lacked cholangiographic evidence of common bile duct stones are reported. One presented 7 yr after cholecystectomy, and the other two had gallbladder sludge but no gallstones. The clinical features were mild, consisting of biliary pain, low grade fever without chills, and with modest leukocytosis. In each case, free cannulation of the bile duct was not possible, necessitating needle-knife papillotomy. After endoscopic sphincterotomy, balloon retrieval yielded purulent bile and sludge, but no stones. Prompt clinical improvement resulted in all three patients. Cultures of bile obtained at endoscopic retrograde cholangiopancreatography grew Escherichia coli in two patients and Enterobacter aeruginosa in the other. These observations suggest a link between intermittent obstruction due to biliary sludge in the common bile duct and bacterial cholangitis. We hypothesize that recurrent passage of biliary sludge may precipitate obstructive inflammation and fibrosis of the ampulla of Vater. Acute cholangitis should be added to the differential of potential complications of biliary sludge.
报告了3例急性胆管炎患者，他们缺乏胆总管结石的胆管造影证据。1例在胆囊切除术后7年出现症状，另外2例有胆囊泥沙样沉积物但无胆结石。临床特征较轻，包括胆绞痛、低热无寒战，伴有轻度白细胞增多。在每例患者中，均无法顺利进行胆管插管，因此需要进行针刀乳头切开术。内镜括约肌切开术后，气囊取出物为脓性胆汁和泥沙样沉积物，但无结石。所有3例患者的临床症状均迅速改善。在内镜逆行胰胆管造影术中获取的胆汁培养物显示，2例患者培养出大肠杆菌，另1例培养出铜绿假单胞菌。这些观察结果提示胆总管内胆汁泥沙样沉积物引起的间歇性梗阻与细菌性胆管炎之间存在联系。我们推测胆汁泥沙样沉积物的反复通过可能会促使 Vater壶腹发生梗阻性炎症和纤维化。急性胆管炎应被列入胆汁泥沙样沉积物潜在并发症的鉴别诊断中。
