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May 1969

The Significance of Biliary Pressure in Cholangitis

Author Affiliations

Galveston, Tex
From the departments of surgery and microbiology, University of Texas Medical Branch and Shriners Burns Institute, Galveston, Tex.

Arch Surg. 1969;98(5):629-632. doi:10.1001/archsurg.1969.01340110121014

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.1 To these, Reynolds and Dargan2 added 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.2-4 An increased intrabiliary pressure, therefore, has been suspected to play a significant role in the pathogenesis of septicemia in cholangitis.2,4,5 In order to determine the significance of biliary pressure in initiating the process of biliary regurgitation of bacteria, an investigation was made in