ACUTE SUPPURATIVE CHOLANGITIS ASSOCIATED WITH CHOLEDOCHAL SLUDGE

Three patients with acute cholangitis who lacked cholangiographic evid ence of common bile duct stones are reported. One presented 7 yr after cholecystectomy, and the other two had gallbladder sludge but no gall stones. The clinical features were mild, consisting of biliary pain, l ow grade fever without chills, and with modest leukocytosis. In each c ase, free cannulation of the bile duct was not possible, necessitating needle-knife papillotomy. After endoscopic sphincterotomy, balloon re trieval yielded purulent bile and sludge, but no stones. Prompt clinic al improvement resulted in all three patients. Cultures of bile obtain ed at endoscopic retrograde cholangiopancreatography grew Escherichia coli in two patients and Enterobacter aeruginosa in the other. These o bservations suggest a link between intermittent obstruction due to bil iary sludge in the common bile duct and bacterial cholangitis. We hypo thesize that recurrent passage of biliary sludge may precipitate obstr uctive inflammation and fibrosis of the ampulla of Vater. Acute cholan gitis should be added to the differential of potential complications o f bilary sludge.