Most are the sequelae of acute cholangitis. After non-surgical treatment for acute cholangitis, the acute inflammation is controlled, but the primary disease causes within the bile ducts (such as intrahepatic or extrahepatic bile duct stones, biliary ascariasis, or Oddi sphincter stenosis, etc.) remain unresolved. The inflammatory lesions in the bile ducts become chronic, leading to thickening of the bile duct walls. Due to the presence of obstructive pathological changes, the bile ducts often dilate, reaching diameters of 2–3 cm or even 5 cm. When the bile duct obstruction becomes complete or bacterial infection worsens, acute inflammation can recur. Repeated acute episodes further exacerbate the chronic inflammatory lesions in the bile ducts, particularly in the Oddi sphincter papilla at the lower end of the bile duct and the branches of the intrahepatic bile ducts. After multiple acute episodes, fibrosis, scar tissue proliferation, and stenosis often develop at the lower end of the bile duct, along with segmental strictures in the branches of the intrahepatic bile ducts. This further aggravates the degree of obstruction in both intrahepatic and extrahepatic bile ducts.

bubble_chart Clinical Manifestations

There are usually no specific symptoms, which may manifest as discomfort and distending pain in the mid-upper abdomen, sometimes presenting as episodes of colicky pain. Upper abdominal pain may worsen after consuming greasy foods. Generally, fever and jaundice are rare. Abdominal signs are also not obvious, with only mild tenderness in the upper abdomen and no enlargement of the gallbladder. If an acute attack occurs, clinical manifestations such as abdominal pain, shivering, high fever, and jaundice may appear as a triad of symptoms.

bubble_chart Diagnosis

The diagnosis is primarily based on a history of recurrent episodes of acute cholangitis. Additionally, B-ultrasound can reveal dilation of the common bile duct, thickening of the duct wall, and sometimes show shadows of stones or ascaris in the bile duct. Intravenous cholangiography demonstrates bile duct dilation, often with delayed contrast agent clearance. ERCP can clearly display dilated bile ducts and lesions such as bile duct stones, as well as identify the presence of stenosis in the intrahepatic or extrahepatic bile ducts. In most cases, a definitive diagnosis can be made based on clinical manifestations and the aforementioned examinations.

bubble_chart Treatment Measures

Surgical treatment is adopted to remove the factors causing bile duct obstruction and ensure smooth biliary drainage. In case of acute episodes, control them first and proceed with surgery once the condition stabilizes. The bile duct is incised to remove stones or roundworms, followed by T-tube drainage. If there is stenosis of the sphincter of Oddi, a sphincteroplasty can be performed. If there is obstruction at the lower end of the common bile duct, biliary-intestinal internal drainage procedures such as choledochoduodenostomy or Roux-en-Y cholangiojejunostomy can be performed. To eliminate the source of infection, cholecystectomy is routinely performed. For intrahepatic bile duct stenosis, the pathological changes must be thoroughly understood, and the cause of obstruction must be addressed, such as incising the stenotic segment of the intrahepatic bile duct, removing intrahepatic stones, and then performing Roux-en-Y cholangiojejunostomy. Reflux cholangitis is prone to occur after sphincteroplasty and choledochoduodenostomy.