Bacterial cholangitis causing secondary sclerosing cholangitis: A case report

Background: Although bacterial cholangitis is frequently mentioned as a cause of secondary sclerosing cholangitis, it appears to be extremely rare, with only one documented case ever reported. Case presentation: A 48-year-old woman presented with an episode of acute biliary pancreatitis that was complicated by pancreatic abcess formation. After 3 months she had an episode of severe pyogenic (E. Coli) cholangitis that recurred over the subsequent 7 months on a further two occasions. Initially, cholangiography suggested the presence of extra-biliary intrahepatic abcesses while repeated investigations demonstrated development of multiple segmental biliary duct strictures. After maintenance antibiotic treatment was started, no episodes of cholangitis occurred over a 14-month period. Conclusions: Sclerosing cholangitis can rapidly develop after an episode of bacterial cholangitis. Extra-biliary involvement of the hepatic parenchyma with abcess formation may be a risk factor for developing this rare but particularly severe complication. Background Secondary sclerosing cholangitis following pyogenic cholangitis is usually listed among the many potential causes of biliary stricture formation (Table) [1,2]. However, in the literature indexed in Medline we could find only one such case, indicating that this is an extremely rare condition. We hereby report a second case, documented by cholangiography, of rapidly progressive sclerosing cholangitis secondary to bacterial cholangitis. Case presentation A previously healthy 48 year-old woman of Moroccan origin was admitted because of abdominal pain and nausea. A diagnosis of acute pancreatitis was made, based on elevated urinary and serum amylase levels and ultrasound imaging. Endoscopic retrograde cholangiopancreatography (ERCP) showed normal bile ducts, but suggested presence of biliary sludge, and biliary sphincterotomy was performed. In the following weeks four laparotomies were required for drainage of multiple pancreatic abcesses. Three months after the initial presentation, the patient was readmitted with jaundice, right upper quadrant abPublished: 3 June 2002 BMC Gastroenterology 2002, 2:14 Received: 28 March 2002 Accepted: 3 June 2002 This article is available from: http://www.biomedcentral.com/1471-230X/2/14 © 2002 ter Borg et al; licensee BioMed Central Ltd. Verbatim copying and redistribution of this article are permitted in any medium for any purpose, provided this notice is preserved along with the article's original URL.