CHOLEDOCHODUODENOSTOMY IN THE TREATMENT OF SUPPURATIVE CHOLANGITIS

Between 1977 and 1995, 27 patients with acute suppurative cholangitis were treated by emergency surgery. Fifteen patients were male and 12 were female. Median age was 53(30-83). The primary pathology was choledocholithiasis in 15 patients, intrabiliary rupture of a hydatid cyts in 9, biliary stricture in one, cholangiocarcinoma associated with Caroil's disease in one, iatrogenic injury in one. The diagnosis was based on Charcot's criteria as well as the presence of hypotension, mental confusion and unresponsiveness to medical therapy. Decompression of the biliary system was achieved by choledochoduodenostomy in 16 patients, T-drainage in 6, T-drainage + sphincteroplasty in two, choledochojejunostomy in one, hepaticojejunostomy in one and external iminage in one. Four patients died in the early postoperative period (mortality: 15%) two were in septic shock at admission; effective drainage could not be achieved in the other two patients due diffuse cholangiocarcinoma in one ad the presence of extremely organized purulent material in the biliary tree in the other. Wound infection developed in four patients, subhepatic abcess in two, renal failure in one, T-drain leakage in one, liver abcess in one. Acute suppurative cholangitis is a rare entity with high mortality. Early diagnosis, rapid and effective biliary lecompression are life-saving in the majority of the cases.

AKUT SÜPÜRATÝF KOLANJÝT TEDAVÝSÝNDE KOLEDOKODUODENOSTOMÝNÝN YERÝ

1977-1995 yýllarý arasýnda 27 hastaya akut süpüratif kolanjit tanýsýyla acil cerrahi giriþim uygulanmýþtýr. Hastalarýn 15'i erkek, 12'si kadýndý. Medyan yaþ 53 idi (30-83). Tabloya sebep olan birincil patoloji; 15 hastada toledokolüyaz, 9 hastada safra yollarýna açýlmýþ kist hidatik, bir hastada biliyer striktür, bir hastada Caroli hastalýðý zemininde geliþmiþ kolanjiokarsinom, bir hastada iatrojenik safra yollarý yaralanmasýydý. Taný; Charcot kriterlerine ek olarak, þoka eðilim, þuur bozukluðu ve medikal tedaviye yanýtsýzlýk ile kondu. Safra yollarýnýn kompresyonu için 16 hastada koledokoduodenostomi, 6 hastada T-drenaj, iki hastada T-drenaj + sfinkteroplasti, bir hastada koledokojejunostomi, bir hastada hepatikojejunostomi, bir hastada eksternal drenaj uygulandý. Ameliyat sonrasýnda kaybedilen dört hastanýn ikisi kliniðe septik þok tablosunda baþvurmuþ, diðer iki hastada ise sýrasýyla safra yollarýndaki pürülan materyalin taþlaþmýþ olmasý ve yaygýn kolanjiokarsinom sebebiyle etkin drenaj yapýlamamýþtýr (mortalite: %15). Dört hastada yara enfeksiyonu, iki hastada subhepatik abse, bir hastada böbrek yetmezliði, bir hastada T-dreni kaçaðý, bir hastada karaciðer absesi saptandý. Akut süpüratif kolanjit, nadir görülen ancak mortalitesi yüksek olan bir tablodur. Erken taný ile hýzlý ve etkin safra yollarý drenajý vakalarýn büyük çoðunluðunda hayat kurtarýcýdýr.