John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Cholangitis in critically ill patients: an underestimated new entity? Volume 22, issue 4, Avril 2015

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Authors
CHU de Rouen, service d’hépato-gastroentérologie, 1 rue de Germont, 76 000 Rouen, France
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Cholangiopathy in intensive care unit (ICU) patients is a new entity and few reports have been published. Patients have no prior history of liver disease and have normal liver function tests before admission in ICU. Jaundice occurs during the first two weeks with rapid and major increase of alkaline phosphatase activity. The diagnosis is based on pathological aspect of the bile ducts on ERCP. Early endoscopic findings include intraductal defects of intrahepatic bile ducts caused by extensive biliary casts. Then, multiple irregular strictures appear with progressive sclerosis. Treatment consists on endotherapy with endoscopic dilatations and extraction of the occluding material after sphincterotomy of the papilla, combined with ursodesoxycholic acid (UDCA). The disease progresses rapidly to biliary cirrhosis and the prognosis is poor. The median survival time free of liver transplantation is 13 months. The pathophysiology is unknown. Hypovolemia and arterial hepatic hypoxia generate ischemic injury in the intrahepatic biliary tree. Use of high-dose vasopressors in combination with high positive expiratory pressure may compromise hepatic perfusion. Finally, sepsis may be also involved.