SERIAL CHOLANGIOGRAPHIC APPEARANCES IN RECURRENT PYOGENIC CHOLANGITIS

From December 1982 to December 1991, cholangiograms were obtained in 2 27 patients with recurrent pyogenic cholangitis. Cholangiographic abno rmalities included biliary dilation, calculi, sludge, excessive branch ing, and arrowhead formation of intrahepatic ducts and biliary strictu res. In 21 patients, previous evidence of biliary ascariasis was seen. Repeat cholangiograms were performed in 55 patients in a follow-up pe riod of 18.0 +/- 1 months. Of these patients, 12 treated conservativel y continued to get recurrent cholangitis and revealed worsening abnorm alities on repeat cholangiograms. Another 25 patients had successful e ndoscopic sphincterotomy and extraction of biliary calculi. These pati ents remained free of symptoms on follow-up, with significant resoluti on of abnormalities on repeat cholangiograms. The remaining 18 patient s with failed surgical or endoscopic interventions continued to get re current episodes of cholangitis and worsening of abnormalities on repe at cholangiograms. This retrospective study indicates that the natural course of recurrent pyogenic cholangitis is a progressive, destructiv e cholangiopathy. Ascaris lumbricoides invasion of the biliary tree is an initiating event in a sub-group of patients.