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Caustic sclerosing cholangitis. Report of four cases and a cumulative review of the literature.
Hepatogastroenterology 1994; 41(5):458-70H

Abstract

We report on four patients of our own and another thirty-six from the literature, who developed almost identical and unusual clinical syndromes after surgical treatment of hydatid disease of the liver, with the aim of showing the extremely serious nature of the problem that can ensue. An association of four factors seems to be necessary to promote caustic sclerosing cholangitis: a) injection of a scolicidal agent (formalin, hypertonic saline, ethanol, silver nitrate or iodine solution) into the cyst cavity; b) a communication between the cyst and the biliary tree; c) a condition that prolongs the exposure of the biliary tree to the scolicidal; and d) a particular sensitivity to the scolicidal agent. While this last condition cannot be anticipated, we may justifiably conclude that surgeons should not inject a scolicidal solution into the hydatid cyst, but prevent intra-abdominal diffusion of the parasite by using hydrogen peroxide, gauze pads moistened by a scolicidal solution or by preoperative chemotherapy with albendazole. Caustic sclerosing cholangitis has an earlier onset of symptoms and a more rapidly progressive nature than primary sclerosing cholangitis. In foresight, serum alkaline phosphatase should be monitored and, when raised, a retrograde endoscopic cholangiogram and/or a liver biopsy should be performed. Digestive shunt surgery should be avoided and the possibility of liver transplantation has to be periodically evaluated.

Authors+Show Affiliations

Department of Internal Medicine, Hospital Doce de Octubre, School of Medicine, Complutense University, Madrid, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

7851856

Citation

Castellano, G, et al. "Caustic Sclerosing Cholangitis. Report of Four Cases and a Cumulative Review of the Literature." Hepato-gastroenterology, vol. 41, no. 5, 1994, pp. 458-70.
Castellano G, Moreno-Sanchez D, Gutierrez J, et al. Caustic sclerosing cholangitis. Report of four cases and a cumulative review of the literature. Hepatogastroenterology. 1994;41(5):458-70.
Castellano, G., Moreno-Sanchez, D., Gutierrez, J., Moreno-Gonzalez, E., Colina, F., & Solis-Herruzo, J. A. (1994). Caustic sclerosing cholangitis. Report of four cases and a cumulative review of the literature. Hepato-gastroenterology, 41(5), pp. 458-70.
Castellano G, et al. Caustic Sclerosing Cholangitis. Report of Four Cases and a Cumulative Review of the Literature. Hepatogastroenterology. 1994;41(5):458-70. PubMed PMID: 7851856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Caustic sclerosing cholangitis. Report of four cases and a cumulative review of the literature. AU - Castellano,G, AU - Moreno-Sanchez,D, AU - Gutierrez,J, AU - Moreno-Gonzalez,E, AU - Colina,F, AU - Solis-Herruzo,J A, PY - 1994/10/1/pubmed PY - 1994/10/1/medline PY - 1994/10/1/entrez SP - 458 EP - 70 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 41 IS - 5 N2 - We report on four patients of our own and another thirty-six from the literature, who developed almost identical and unusual clinical syndromes after surgical treatment of hydatid disease of the liver, with the aim of showing the extremely serious nature of the problem that can ensue. An association of four factors seems to be necessary to promote caustic sclerosing cholangitis: a) injection of a scolicidal agent (formalin, hypertonic saline, ethanol, silver nitrate or iodine solution) into the cyst cavity; b) a communication between the cyst and the biliary tree; c) a condition that prolongs the exposure of the biliary tree to the scolicidal; and d) a particular sensitivity to the scolicidal agent. While this last condition cannot be anticipated, we may justifiably conclude that surgeons should not inject a scolicidal solution into the hydatid cyst, but prevent intra-abdominal diffusion of the parasite by using hydrogen peroxide, gauze pads moistened by a scolicidal solution or by preoperative chemotherapy with albendazole. Caustic sclerosing cholangitis has an earlier onset of symptoms and a more rapidly progressive nature than primary sclerosing cholangitis. In foresight, serum alkaline phosphatase should be monitored and, when raised, a retrograde endoscopic cholangiogram and/or a liver biopsy should be performed. Digestive shunt surgery should be avoided and the possibility of liver transplantation has to be periodically evaluated. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/7851856/Caustic_sclerosing_cholangitis__Report_of_four_cases_and_a_cumulative_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -