Información del artículo
Resumen
La colangitis aguda es una infección potencialmente grave de las vías biliares, que se produce como consecuencia de una obstrucción a dicho nivel. La litiasis coledocal es la causa más frecuente de la colangitis. La obstrucción de la vía biliar y la colonización bacteriana subsiguiente condicionan la aparición de la infección. Los microorganismos de la flora entérica, aerobios y, en menor grado, anaerobios, son los agentes causales en la mayoría de casos. La denominada tríada de Charcot constituye la sintomatología clínica más frecuente. El diagnóstico se confirma mediante técnicas radiológicas abdominales, entre las que se incluyen la ecografía, la tomografía computarizada y la colangiorresonancia magnética, en las que se detectan signos de obstrucción de la vía biliar y, en muchas ocasiones, la causa subyacente de ésta. El tratamiento antimicrobiano apropiado precoz y el drenaje biliar, generalmente efectuado mediante técnicas endoscópicas, son la terapia de elección en la mayoría de pacientes.
Palabras clave:
Colangitis aguda
Infección vías biliares
Drenaje biliar
Sepsis biliar
Abstract
Acute cholangitis is a potentially severe infection of the biliary tract, resulting from a biliary obstruction. The most frequent cause of cholangitis is common duct stones. Biliary tract obstruction and secondary bacterial colonization lead to infection. In most cases, the causative agents are intestinal microflora, mostly aerobic microorganisms (and, to a lesser extent, anaerobic bacteria). The Charcot triad constitutes the most frequent symptomatology. Diagnosis is confirmed by means of radiological techniques, such as ultrasonography, computed tomography scan, or magnetic resonance imaging of the liver, in which signs of obstruction of the biliary tract can be detected and its etiology can often be determined. In most patients the treatment of choice is early appropriate antimicrobial therapy and biliary drainage, generally using endoscopic techniques.
Keywords:
Acute cholangitis
Biliary tract infection
Biliary drainage
Biliary sepsis
El Texto completo está disponible en PDF
Bibliografía
[1.]
Y. Kimura, T. Takada, Y. Kawarada, Y. Nimura, K. Hirata, M. Sekimoto, et al.
Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.
J Hepatobiliary Pancreat Surg, 14 (2007), pp. 15-26
[2.]
S. Attasaranya, E.L. Fogel, G.A. Lehman.
Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis.
Med Clin North Am, 92 (2008), pp. 925-960
[3.]
W.A. Qureshi.
Approach to the patient who has suspected acute bacterial cholangitis.
Gastroenterol Clin North Am, 35 (2006), pp. 409-423
[4.]
B.M. Reynolds, E.L. Dargan.
Acute obstructive cholangitis. A distinct syndrome.
Ann Surg, 150 (1959), pp. 299-303
[5.]
I.F. Yusoff, J.S. Barkun, A.N. Barkun.
Diagnosis and management of cholecystitis and cholangitis.
Gastroenterol Clin North Am, 32 (2003), pp. 1145-1168
[6.]
L.H. Hanau, N.H. Seitgbigel.
Acute (ascending) cholangitis.
Infect Dis Clin North Am, 14 (2000), pp. 521-546
[7.]
W.P. Longmire.
Suppurative cholangitis.
Critical surgical illness, pp. 397-424
[8.]
A. Csendes, A. Sepulveda, P. Burdiles, I. Braghetto, J. Bastias, H. Schütte, et al.
Common bile duct pressure in patients with common bile duct stones with or without acute suppurative cholangitis.
Arch Surg, 123 (1988), pp. 697-699
[9.]
W.G. Jiang, M.C.A. Puntis.
Immune dysfunction in patients with obstructive jaundice, mediators and implications for treatment.
HPB Surg, 10 (1997), pp. 129-142
[10.]
J. Rodríguez-Baño, D. Navarro, L. Romero, M. Muniain, M. Cueto, J. Ríos, et al.
Bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli in the CTXM era: a new challenge.
Clin Infect Dis, 43 (2006), pp. 1407-1414
[11.]
J. Rodriguez-Baño, M.D. Navarro.
Extended-spectrum betalactamases in ambulatory care: a clinical perspective.
Clin Microbiol Infect, 1 (2008), pp. 104-110
[12.]
J. Rodríguez-Baño, D. Navarro, L. Romero, M. Muniain, M. Cueto, J. Gálvez, et al.
Risk factors for emerging bloodstream infections caused by extended-spectrum betalactamase producing Escherichia coli.
Clin Microbil Infect, 14 (2008), pp. 180-183
[13.]
J. Rodríguez-Baño, J.C. Alcalá, J.M. Cisneros, F. Grill, A. Oliver, J.P. Horcajada, et al.
Community infections caused by extended-spectrum beta-lactamase producing Escherichia coli.
Arch Intern Med, 168 (2008), pp. 1897-1902
[14.]
B.W. Frazee, S. Hansen, L. Lambert.
Invasive infection with hipermucoviscous Klebsiella pneumoniae: multiple cases presenting to a single emergency department in the Uniated States.
Ann Emerg Med, 53 (2009), pp. 639-642
[15.]
J.K. Kim, D.R. Chung, S.H. Wie, J.H. Yoo, S.W. Park.
Risk factors of invasive liver abscess caused by the K1 serotype Klebsiella pneumoniae.
Eur J Clin Microbiol Infect Dis, 28 (2009), pp. 109-111
[16.]
A. Rodríguez, J.A. Maradona, J.A. Cartón, N. Hooker, J.L. Alonso, V. Asensi, et al.
Pseudomonas aeruginosa bacteremia as a complication after endoscopic retrograde cholangiopancreatography.
Enferm Infecc Microbiol Clin, 15 (1997), pp. 540-543
[17.]
R. Reiss, A. Eliashiv, A.A. Deutsch.
Septic complications and bile cultures in 800 consecutive cholecystectomies.
World J Surg, 6 (1982), pp. 195-199
[18.]
K. Wada, T. Takada, Y. Kawarad, Y. Nimura, F. Miura, M. Yoshida, et al.
Diagnostic criteria and severity assesment of acute cholangitis: Tokio Guidelines.
J Hepatobiliary Pancreat Surg, 14 (2007), pp. 52-58
[19.]
P.A. Abboud, P.F. Malet, J.A. Berlin, R. Staroscik, M.D. Cabana, J.R. Clarke, et al.
Predictors of common bile ducts stones prior to cholecystectomy: a meta-analysis.
Gastrointest Endosc, 44 (1996), pp. 450-455
[20.]
K.J.W. Taylor, A.T. Rosenfield, H.M. Spiro.
Diagnostic accuracy of grey scale ultrasonography for the jaundiced patient.
Arch Intern Med, 139 (1979), pp. 60-63
[21.]
R.L. Baron, R.J. Stanley, J.K. Less, R.E. Koehler, G.L. Melson, D.M. Balfe, et al.
A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography.
Radiology, 145 (1982), pp. 91-98
[22.]
R.N. Gibson, E. Yeung, J.N. Thompson, D.H. Carr, A.P. Hemingway, H.A. Bradpiece, et al.
Bile duct obstruction: radiologic evaluation of level, cause, and tumor respectability.
Radiology, 160 (1986), pp. 43-47
[23.]
P.A. Pasanen, K. Partanen, P. Pikkarainen, E. Alhava, A. Pirnene, E. Janatuinen.
Diagnostic accuracy of ultrasound, computed tomography, and endoscopic retrograde chloangiopancreatography in the detection of obstructive jaundice.
Scand J Gastroenterol, 26 (1991), pp. 1157-1164
[24.]
K. Hakansson, O. Ekberg, H.O. Hakansson, P. Leander.
MR and ultrasonography in sreening of patients with suspected biliary tract disease.
Acta Radiol, 43 (2002), pp. 80-86
[25.]
T.R. Bader, L. Braga, K.L. Beavers, R.C. Semelka.
MR imaging findings of infectious cholangitis.
Magn Reson Imaging, 19 (2001), pp. 781-788
[26.]
J. Romagnuolo, M. Bardou, E. Rahme, L. Joseph, C. Reinhold, A.N. Barkun.
Magnetic resonanace cholangiopancreatography: a meta-aanlysis of test performance in suspected biliary disease.
Ann Intern Med, 139 (2003), pp. 547-557
[27.]
M.G. Raraty, M. Finch, J.P. Neoptolemos.
Acute cholangitis and pancreatitis secondary to common duct stones: management update.
World J Surg, 22 (1998), pp. 1155-1161
[28.]
J.W. Leung, T.K. Ling, R.C. Chan, S.W. Cheung, C.W. Lai, J.J. Sung, et al.
Antibiotics, biliary sepsis, and bile duct stones.
Gastrointest Endosc, 40 (1994), pp. 716-721
[29.]
J.S. Dooley, J.M. Hamilton-Miller, W. Brumfitt, S. Sherlock.
Antibiotics in the treatment of biliary infection.
Gut, 25 (1984), pp. 988-998
[30.]
J. Westphal, J. Brogard.
Biliary tract infections: a guide to drug treatment.
Drugs, 57 (1999), pp. 81-91
[31.]
M.K. Jain.
Acute bacterial cholangitis.
Current Treat Option Gastroenterol, 9 (2006), pp. 113-121
[32.]
A. Tanaka, T. Takada, Y. Kawarada, Y. Nimura, M. Yoshida, F. Miura, et al.
Antimicrobial therapy for acute cholangitis: Tokyo Guidelines.
J Hepatobiliary Pancreat Surg, 14 (2007), pp. 59-67
[33.]
J.E. Thompson Jr., H.A. Pitt, J.E. Doty, J. Coleman, C. Irving.
Broad spectrum penicillin as an adequate therapy for acute cholangitis.
Surg Gynecol Obstet, 171 (1990), pp. 275-282
[34.]
J.J. Sung, D.J. Lyon, R. Suen, S.C. Chung, A.L. Co, A.F. Cheng, et al.
Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial.
J Antimicrob Chemother, 35 (1995), pp. 855-864
[35.]
J.W. Leung, R.C. Chan, S.W. Cheung, J.Y. Sung, S.C. Chung, G.L. French.
The effect of obstruction on the biliary excretion of cefoperazone and ceftazidime.
J Antimicrob Chemother, 25 (1990), pp. 399-406
[36.]
J. Leung, C. Chan, C. Lai, T. Ko, A. Cheng, G. French.
Effect of biliary obstruction on the hepatic excretion of imipenem-cilastatin.
Antimicrob Agents Chemother, 36 (1992), pp. 2057-2060
[37.]
S. Van den Hazel, X. De Vries, P. Speelman, J. Dankert, G. Tytgat, K. Huibregtse, et al.
Biliary excretion of ciprofloxacin and piperacillin in the obstructed biliary tract.
Antimicrob Agents Chemother, 40 (1996), pp. 2658-2660
[38.]
J.E. Thompson Jr., R. Bennion, R. Roettger, K. Lally, J. Hopkins, S.E. Wilson.
Cefepime for infections of the biliary tract.
Surg Gynecol Obstet, 177 (1993), pp. 30-34
[39.]
Investigators of the Piperacillin/Tazobactam Intra-abdominal Infection Study Group.
Results of the North American trial of piperacillin/tazobactam compared with clindamycin and gentamicin in the treatment of severe intra-abdominal infections.
Eur J Surg, 573 (1994), pp. 61-66
[40.]
J. Solomkin, J. Mazuski, E. Baron, R. Sawyer, A. Nathens, J. DiPiro, et al.
Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections.
Clin Infect Dis, 37 (2003), pp. 997-1005
[41.]
T. Desai, T. Tsang.
Aminoglycoside nephrotoxicity in obstructive jaundice.
Am J Surg, 85 (1988), pp. 47-50
[42.]
C. Lucasti, A. Jasovich, O. Umeh, J. Jiang, K. Kaniga, I. Friedland.
Efficacy and tolerability of IV doripenem versus meropenem in adults with complicated intra-abdominal infection: a phase III, prospective, multicenter, randomized, double-blind, noninferiority study.
Clin Ther, 30 (2008), pp. 868-883
[43.]
O. Malafaia, O. Umeh, J. Jiang.
Doripenem versus meropenem for the treatment of complicated intra-abdominal infections.
46th Interscience Conference on Antimicrobial Agents and Chemotherapy, pp. 27-30
[44.]
J.S. Solomkin, O. Umeh, J. Jiang, K. Kaniga, I. Friendlund.
Doripenem vs. meropenem with an option for oral step-down therapy in the treatment of complicated intra-abdominal infections [abstract].
47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, pp. 17-20
[45.]
M. Sugiyama, Y. Atomi.
Treatment of acute cholangitis due to choledocholithiasis in elderly and younger patients.
Arch Surg, 132 (1997), pp. 1129-1133
[46.]
A.U. Van Lent, J.F. Bartelsman, G.N. Tytgat, P. Speelman, J.M. Prins.
Duration of antibiotic therapy for cholangitis after successful endoscopic drainage of the biliary tract.
Gastrointest Endosc, 55 (2002), pp. 518-522
[47.]
C.K. Hui, K.C. Lai, W.M. Wong, M.F. Yuen, S.K. Lam, C.L. Lai.
A randomised controlled trial of endoscopic sphincterotomy in acute cholangitis without common bile duct stones.
Gut, 51 (2002), pp. 245-247
[48.]
J. Boender, G.A. Nix, M.A. De Ridder, J. Dees, H.E. Schütte, H.R. Van Buuren, et al.
Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones.
Am J Gastroenterol, 90 (1995), pp. 233-238
[49.]
T. Leese, J.P. Neoptolemos, A.R. Baker, D.L. Carr-Locke.
Management of acute cholangitis and the impact of endoscopic sphincterotomy.
Br J Surg, 73 (1986), pp. 988-992
[50.]
E.C. Lai, F.P. Mok, E.S. Tan, C.M. Lo, S.T. Fan, K.T. You, et al.
Endoscopic biliary drainage for severe acute cholangitis.
N Engl J Med, 326 (1992), pp. 1582-1586
[51.]
H. Ditzel, O.B. Schaffalitzky de Muckadell.
Endoscopic sphincterotomy in acute cholangitis due to choledocholithiasis.
Hepatogastroenterology, 37 (1990), pp. 204-207
[52.]
K. Chijiiwa, N. Kozaki, T. Naito, N. Kameoka, M. Tanaka.
Treatment of choice for choledocholithiasis in patients with acute obstructive suppurative cholangitis and liver cirrhosis.
Am J Surg, 170 (1995), pp. 356-360
[53.]
S. Koklu, E. Parlak, O. Yuksel, B. Sahin.
Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study.
Age Ageing, 34 (2005), pp. 572-577
[54.]
J.M. Huguet, J. Sempere, I. Bort, P. Canelles, E. Rodríguez, A.B. Durá, et al.
Complications of endoscopic retrograde cholangiopancreatography in patient aged more than 90 years old.
Gastroenterol Hepatol, 28 (2005), pp. 263-266
[55.]
D.W. Lee, A.C. Chan, Y.H. Lam, E.K. Ng, J.Y. Lau, B.K. Law, et al.
Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial.
Gastrointest Endosc, 56 (2002), pp. 361-365
[56.]
B.C. Sharma, R. Kumar, N. Agarwal, S.K. Sarin.
Endoscopic biliary drainage by nasobiliary drain or by stent placement in patients with acute cholangitis.
Endoscopy, 37 (2005), pp. 439-443
[57.]
M. Sugiyama, Y. Atomi.
The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis.
Am J Gastroenterol, 93 (1998), pp. 2065-2068
[58.]
M.L. Freeman, D.B. Nelson, S. Sherman, G.B. Haber, M.E. Herman, P.J. Dorsher, et al.
Complications of endoscopic biliary sphincterotomy.
N Engl J Med, 335 (1996), pp. 909-918
[59.]
D.R. Burke, C.A. Lewis, J.F. Cardella, S.J. Citron, A.T. Drooz, Z.J. Haskal, et al.
Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage.
J Vasc Interv Radiol, 14 (2003), pp. S243-S246
[60.]
P.K. Joseph, L.S. Bizer, S.S. Sprayregen, M.L. Gliedman.
Percutaneous transhepatic biliary drainage: results and complications in 81 patients.
JAMA, 255 (1986), pp. 2763-2767
[61.]
M.E. Pessa, I.F. Hawkins, S.B. Vogel.
The treatment of acute cholangitis: percutaneous transhepatic biliary drainage before definitive therapy.
Ann Surg, 205 (1987), pp. 389-392
[62.]
E.C. Lai, P.C. Tam, I.A. Paterson, M.M. Ng, S.T. Fan, T.K. Choi, et al.
Emergency surgery for severe acute cholangitis: the high-risk patients.
Ann Surg, 211 (1990), pp. 55-59
Copyright © 2010. Elsevier España S.L.. Todos los derechos reservados
