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Pathogenesis and clinical features of acute cholangitis accompanied by shock

We investigated 91 cases of acute cholangitis, including 42 of severe cholangitis and 49 of mild cholangitis. The incidence of endotoxemia was 78.6 percent in 42 and 32.6 percent in the 49 patients. In the 42 with severe cholangitis, remarkable leukocytosis, thrombocytopenia, decrease of serum CH50, C3, plasma fibronectin and phagocytic index were characteristic. Disseminated intravascular coagulation (DIC) was observed in 76.2 percent. Since there was a positive correlation between platelet counts and levels of CH50 and C3, the decrease of platelet count, and the occurrence of DIC in patients with endotoxemia were thought to be closely related to the consumption of complements. There was no difference in mortality rate between nonsurgical treatment (57.8 percent) and the emergency bile drainage treatment (56.5 percent). The results of therapy depended on the degree of complicating DIC. We conclude that acute cholangitis was aggravated by endotoximia and that severe cholangitis was accompanied by DIC induced by a decline in phylaxis.

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1. Hiroshi Shimada

   Present address: The First Department of Surgery, Fukui Medical School, Shimoaizuki, Matsuoka-cho, Yoshida-gun, 910-11, Fukui, Japan

1. The Second Department of Surgery, School of Medicine, Yokohama City University, Japan

   Mamoru Kobayashi & Shuji Tsuchiya

2. The Department of Surgery, Yokohama Red Cross Hospital, Japan

   Takuya Kudo & Shuhei Morita

3. The First Department of Surgery, Fukui Medical School, Shimoaizuki, Matsuoka-cho, Yoshida-gun, 910-11, Fukui, Japan

   Gizo Nakagawara

1. Hiroshi Shimada
2. Gizo Nakagawara
3. Mamoru Kobayashi
4. Shuji Tsuchiya
5. Takuya Kudo
6. Shuhei Morita

Shimada, H., Nakagawara, G., Kobayashi, M. et al. Pathogenesis and clinical features of acute cholangitis accompanied by shock. The Japanese Journal of Surgery 14, 269–277 (1984). https://doi.org/10.1007/BF02469641

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• Received: 27 June 1983

• Issue Date: July 1984

• DOI: https://doi.org/10.1007/BF02469641

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