Factors influencing the mortality in surgical treatment of acute cholangitis

H. Hakan MERSİN, İskender SAYEK, Metin ÇAKMAKÇI, Demirali ONAT, Burhan KABAY

Abstract

Acute cholangitis accompanying significant morbidity and mortality is a potentially life-threatening disease. The aim of this study is to evaluate the surgical treatment of acute cholangitis and to assess the factors affecting mortality. Sixty-five patients who were treated surgically were evaluated retrospectively. Thirty-seven women and 28 men were studied. Their ages ranged from 23 to 90 years (mean 57.5). Acute cholangitis was diagnosed when there was clinical evidence of infection and biliary tract obstruction, confirmed by radiological and operative findings. The most common etiologic factors were choledocholithiasis in 43 (66 %) patients, malignant strictures in 11 (17%) patients and being strictures in 11 (17 %) patients. The overall mortality and morbidity rates were 12 % and 35 % respectively. The mortality in patients with acute cholangitis due to malignant strictures was significantly higher than in patients with cholangitis due to choledocholitiasis and benign strictures (p=0.023). Advanced age was not a factor affecting mortality. The mortality rate in patients with high bilirubin levels were significantly higher (p=0.042). The mortality rate in patients with acute cholangitis accompanied with hypotension was 40 % and that accompanied with mental confusion was 75 %. Biliary drainage was performed externally in 41 patients (63 %) and internally in 24 (37 %). The mortality rates in patients who underwent external biliary drainage were 29 % and 2.4 % respectively. The morbidity rates in patients who underwent external and internal biliary drainage were 37.5 % and 34.1 % respectively. In conclusion underlying malignancy, high bilirubin level, hypotension, mental confusion and external decompression of the biliary tree are risk factors increasing mortality rate significantly in patients with acute cholangitis.

Özet

Akut kolanjit, günümüzde de, tanı ve tedavi açısından sorun yaratan, yüksek morbidite ve mortaliteye sahip bir hastalıktır. Bu çalışmada akut kolanjitin cerrahi tedavisinin değerlendirilerek mortaliteye etki eden faktörlerin saptanması amaçlanmıştır. Akut kolanjit tanısıyla cerrahi tedavi uygulanan 65 hasta retrospektif olarak incelendi. Akut kolanjit tanısı infeksiyonun klinik belirtilerinin olması, radyolojik veya ameliyat bulguları ile safra yolları tıkanıklığının saptanması ile konuldu. Hastaların ortalama yaşı 57.5 (23-90) olup, hastaların 37'si kadın, 28'i erkekti. Etyolojik faktörler olarak 43 (% 66) hastada safra yollarında taş, 11 (% 17) hastada malign, 11 (% 17) hastada benign hastalıklara ikincil darlıklar saptandı. Tüm hastalar için mortalite % 12, morbidite % 35 olarak bulundu. Taş ve benign darlıklara ikincil kolanjit gelişenlerde mortalite % 7.4, malign hastalıklara ikincil gelişenlerde % 36.3'tü (p=0.023). Yaşın mortaliteyi etkileyen bir faktör olmadığı, buna karşılık bilirubin düzeyi yüksek olan hastalarda mortalitenin daha fazla olduğu görüldü (p-0.042). Charcot triadı olarak tanımlanan ateş, sarılık ve sağ üst kadran ağrısına ek olarak bilinç bulanıklığı olan hastalarda mortalite % 75, hipotansiyonu olan hastalarda ise % 40 bulundu