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Oriental Cholangiohepatitis (Recurrent Pyogenic Cholangitis)

Oriental cholangiohepatitis (OCH) or recurrent pyogenic cholangitis (RPC) represents a different disease from "Western" biliary stone disease. Not only are the demographics and the treatment for the two disorders quite different, but the chemical composition of the associated calculi differs. In OCH or RPC there are pigmented stones in the bile ducts whereas most Western biliary disease is caused by cholesterol stones. Since sepsis and cholangitis associated with the acute phase of RPC may be fatal, rapid diagnosis is essential to prevent a disastrous outcome. As ultrasound is usually the first diagnostic test performed in patients with symptoms of biliary disease, the alert radiologist is often the first physician to recognize the typical findings and suggest further workup with CT or biliary studies such as transhepatic cholangiography or endoscopic retrograde cholangiopancreatography (ERCP).

Synonyms

Oriental cholangiohepatitis. Recurrent pyogenic cholangitis. Intrahepatic pigment stone disease. Primary intrahepatic stones. Biliary obstruction of the Chinese.

Definition

Oriental cholangiohepatitis or RPC is a recurrent and chronic infection of the biliary tract seen in the Oriental population of Southeast Asia, and particularly in China and Hong Kong. The etiology of RPC remains unclear, but it is associated with bacterial infection by Escherichia coli and with biliary stasis, intrahepatic pigmented stones, and nutritional deficiency. Clonorchis sinensis flukes and Ascaris lumbricoides roundworms are often present in, and frequently cause partial or complete obstruction of, the bile ducts of patients with RPC.

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