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Abstract Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and hel...
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Abstract Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 ( TG 13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 ( TG 18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG 18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG 18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included.
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Melioidosis is a disease prevalent in the tropics, especially in Southeast Asia. The most common clinical presentations are bacteremic pneumonia and abscess formation in various organs. Although a wide variety of disease presentat...
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Melioidosis is a disease prevalent in the tropics, especially in Southeast Asia. The most common clinical presentations are bacteremic pneumonia and abscess formation in various organs. Although a wide variety of disease presentations are reported for melioidosis, acute cholangitis has not been previously reported. Herein, we report a 54-year-old woman who had fever, right upper abdominal pain and jaundice 1 week after a flood caused by a typhoon in southern Taiwan. Acute cholangitis and pneumonia with septic shock caused by Burkholderia pseudomallei were subsequently diagnosed.
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A 66-year-old man was admitted to our hospital because of right hypochondralgia and fever after colonic polypectomy. Endoscopic examination revealed purulent bile excretion from the duodenal papilla orifice; based on this finding,...
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A 66-year-old man was admitted to our hospital because of right hypochondralgia and fever after colonic polypectomy. Endoscopic examination revealed purulent bile excretion from the duodenal papilla orifice; based on this finding, acute suppurative cholangitis was diagnosed. An endoscopic retrograde cholangiography revealed no abnormality in the biliary tree. However, chronic cholestasis persisted, and endoscopic cholangiography performed 4 months later disclosed a beaded appearance of the intrahepatic bile ducts; this sign is a characteristic finding of sclerosing cholangitis. This is the first report of rapid progression of acute suppurative cholangitis to secondary sclerosing cholangitis sequentially followed-up by endoscopic retrograde cholangiography.
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Acute biliary infection (acute cholecystitis and acute cholangitis) is one of the common emergency conditions which carries significant morbidity and mortality. The risk factors are often associated with gallstones, biliary stasis...
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Acute biliary infection (acute cholecystitis and acute cholangitis) is one of the common emergency conditions which carries significant morbidity and mortality. The risk factors are often associated with gallstones, biliary stasis and bile infection. Gram-negative bacteria are frequent isolates from bile and blood cultures in infectious cholangitis. Endotoxaemia from the gram-negative microbes results in circulatory shock and organ dysfunction. Therefore, prompt diagnosis with severity stratification and recognition of its potential rapid progression to life-threatening shock and multi-organ failure ensure execution of the three fundamental interventions in the initial management strategy, namely: resuscitation to support the organ, antimicrobial therapy and biliary decompression drainage to control the infection. This is the core principle in the management of severe acute cholangitis.
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Choledocholithiasis is preferably treated by endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone removal, to reduce the risk for acute cholangitis. Frequently, patients who are ill, surgically unfit...
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Choledocholithiasis is preferably treated by endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone removal, to reduce the risk for acute cholangitis. Frequently, patients who are ill, surgically unfit, or unable to undergo stone extraction during the index procedure underwent antibacterial treatment and temporary biliary stenting via ERCP to prevent biliary sepsis and septic shock. After a period of convalescence, a repeat ERCP is scheduled to clear the bile duct and remove the stent, followed by laparoscopic cholecystectomy to complete the treatment circuit. Cholangitis may often recur in patients with an indwelling biliary stent while waiting for definitive treatment. Here, we present a case of a 42-year-old female with choledocholithiasis who developed moderate acute cholangitis 5 months after ERCP and insertion of a biliary plastic stent. She was provisionally diagnosed with obstructive jaundice with concurrent acute cholecystitis. Through intravenous antibacterial therapy, stent exchange, and an interval open cholecystectomy, she had fully recovered. We also discuss the underlying mechanism of stent blockage and the optimal interval for stent exchange after temporary placement for benign cases. Understanding the pathophysiology of stent clogging and recognizing the optimal interval for stent replacement may help reduce the risk of stent clogging and potentially fatal acute cholangitis.
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Acute lithiasis cholangitis is a rare non‐obstetric emergency during pregnancy, which may threaten fetus and mother's life. It requires a codified management in order to avoid complications. In this current study, we aimed to rep...
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Acute lithiasis cholangitis is a rare non‐obstetric emergency during pregnancy, which may threaten fetus and mother's life. It requires a codified management in order to avoid complications. In this current study, we aimed to report our center experience in the management of acute lithiasis cholangitis occurring in three pregnant women.
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While referring to the evidence adopted in the Tokyo Guidelines 2007 (TG07) as well as subsequently obtained evidence, further discussion took place on terminology, etiology, and epidemiological data. In particular, new findings h...
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While referring to the evidence adopted in the Tokyo Guidelines 2007 (TG07) as well as subsequently obtained evidence, further discussion took place on terminology, etiology, and epidemiological data. In particular, new findings have accumulated on the occurrence of symptoms in patients with gallstones, frequency of severe cholecystitis and cholangitis, onset of cholecystitis and cholangitis after endoscopic retrograde cholangiopancreatography and medications, mortality rate, and recurrence rate. The primary etiology of acute cholangitis/cholecystitis is the presence of stones. Next to stones, the most significant etiology of acute cholangitis is benign/malignant stenosis of the biliary tract. On the other hand, there is another type of acute cholecystitis, acute acalculous cholecystitis, in which stones are not involved as causative factors. Risk factors for acute acalculous cholecystitis include surgery, trauma, burn, and parenteral nutrition. After 2000, the mortality rate of acute cholangitis has been about 10 %, while that of acute cholecystitis has generally been less than 1 %. After the publication of TG07, diagnostic criteria and severity assessment criteria were standardized, and the distribution of cases according to severity and comparison of clinical data among target populations have become more subjective. The concept of healthcare-associated infections is important in the current treatment of infection. The treatment of acute cholangitis and cholecystitis substantially differs from that of community-acquired infections. Cholangitis and cholecystitis as healthcare-associated infections are clearly described in the updated Tokyo Guidelines (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html. ? 2012 Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer.
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摘要 :
While referring to the evidence adopted in the Tokyo Guidelines 2007 (TG07) as well as subsequently obtained evidence, further discussion took place on terminology, etiology, and epidemiological data. In particular, new findings h...
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While referring to the evidence adopted in the Tokyo Guidelines 2007 (TG07) as well as subsequently obtained evidence, further discussion took place on terminology, etiology, and epidemiological data. In particular, new findings have accumulated on the occurrence of symptoms in patients with gallstones, frequency of severe cholecystitis and cholangitis, onset of cholecystitis and cholangitis after endoscopic retrograde cholangiopancreatography and medications, mortality rate, and recurrence rate. The primary etiology of acute cholangitis/cholecystitis is the presence of stones. Next to stones, the most significant etiology of acute cholangitis is benign/malignant stenosis of the biliary tract. On the other hand, there is another type of acute cholecystitis, acute acalculous cholecystitis, in which stones are not involved as causative factors. Risk factors for acute acalculous cholecystitis include surgery, trauma, burn, and parenteral nutrition. After 2000, the mortality rate of acute cholangitis has been about 10 %, while that of acute cholecystitis has generally been less than 1 %. After the publication of TG07, diagnostic criteria and severity assessment criteria were standardized, and the distribution of cases according to severity and comparison of clinical data among target populations have become more subjective. The concept of healthcare-associated infections is important in the current treatment of infection. The treatment of acute cholangitis and cholecystitis substantially differs from that of community-acquired infections. Cholangitis and cholecystitis as healthcare-associated infections are clearly described in the updated Tokyo Guidelines (TG13).
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