How to treat bile duct inflammation after cholecystectomy

After cholecystectomy, cholangitis is also a common inflammation of the bile duct. The most common one is cholangitis. Generally, it is caused by bacterial infection due to bile congestion. At this time, bacteria can reach the bile duct through the lymphatic system or blood circulation, or through the intestine and enter the bile duct through the duodenum. When cholangitis occurs, it must be treated promptly to avoid greater harm.

Clinical manifestations

The disease often presents as discomfort, bloating, or colic in the upper abdomen. The pain in the upper abdomen may be aggravated after eating greasy food. Fever and jaundice are rare. The abdominal signs are not obvious, and there may only be mild tenderness in the upper abdomen and no enlargement of the gallbladder. If an acute attack occurs, the triple symptom of abdominal pain, chills, high fever and jaundice will appear. In addition to the Charcot triad of acute cholangitis (abdominal pain, chills, high fever, and jaundice), there are also manifestations of shock and central nervous system suppression, which is called Reynolds pentad. The onset of this disease is often sudden, with severe and persistent pain under the xiphoid process or in the right upper abdomen. Chills and remittent fever then occur, and the body temperature may exceed 40°C. It is often accompanied by nausea, vomiting, and jaundice, but the severity of the jaundice may not be consistent with the severity of the disease. Nearly half of the patients experience symptoms of central nervous system inhibition such as irritability, impaired consciousness, drowsiness and even coma, and often experience a drop in blood pressure. It often indicates that the patient has developed sepsis and septic shock, indicating that the condition is critical.

Treatment 1. Chronic cholangitis

For patients with intrahepatic bile duct stenosis, it is necessary to thoroughly understand its pathological changes and eliminate the cause of its obstruction. For example, the stricture of the intrahepatic bile duct is incised, and the intrahepatic stones are removed, and then a Roux-y choledochojejunostomy is performed. Reflux cholangitis is prone to occur after sphincter of Oddi plasty and choledochoduodenostomy.

The surgical method should be simple and effective, mainly including bile duct incision, exploration and drainage. It should be noted that the drainage tube must be placed proximal to the bile duct obstruction. Drainage distal to the obstruction is ineffective and the condition cannot be relieved. If the condition permits, it can be removed.