The Significance of Biliary Pressure in Cholangitis

Abstract

Acute suppurative cholangitis is a clinical catastrophe characterized by the obstruction of bile flow with an accumulation of purulent material in the bile ducts under pressure. The classical features of this syndrome are jaundice, chills, fever, and pain in the right upper quadrant of the abdomen.¹To these, Reynolds and Dargan²added delirium and shock as the identifying features of this disease. The circulatory failure encountered is that of septic shock and usually presents as a terminal event. The most pertinent pathological finding in these patients at the time of surgery is that of common bile duct obstruction markedly distended with purulent materials.^2-4An increased intrabiliary pressure, therefore, has been suspected to play a significant role in the pathogenesis of septicemia in cholangitis.^2,4,5In order to determine the significance of biliary pressure in initiating the process of biliary regurgitation of bacteria, an investigation was made in