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HPB Surgery
Volume 8, Issue 4, Pages 267-273
http://dx.doi.org/10.1155/1995/51915

Biochemical Prediction of Acute Cholangitis and Symptomatic Bile Duct Stones by Gallstone Hepatitis

Department of Surgery, Ogaki Municipal Hospital, 4–86, Minaminokawa, Ogaki, 503, Japan

Received 28 October 1993

Copyright © 1995 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We have adopted the clinical concept of gallstone hepatitis indicated by marked serum transaminase elevation due to an acute inflammatory liver cell necrosis in the early stages of gallstone impaction in the bile duct as clinical and biochemical criteria for identifying high-risk patients for acute cholangitis or bile duct stones causing symptoms (symptomatic bile duct stones, SBDS).

One hundred and fifty-eight (80.2%) of 197 patients with acute gallstone disease and concomitant elevation of serum transaminase (gallstone hepatitis) underwent emergency treatment, either surgery (138 patients) or percutaneous transhepatic biliary drainage (PTBD)/endoscopic sphincterotomy (ES) (20 patients). One hundred and forty-two (89.9%) and 67 (42.4%) were confirmed to have SBDS and acute cholangitis, respectively, in the early stage of the disease. The majority of the patients who had no bile duct stones identified at surgery had either biliary pancreatitis or multiple small stones in the gallbladder. They were assumed to have migrating stones or false negative operative cholangiograms.

In conclusion, gallstone hepatitis indicates that SBDS and acute cholangitis are probable, and facilitates rapid selection of patients for urgent biliary tract exploration in patients with acute gallstone disease.