BACKGROUND: Recurrent pyogenic cholangitis is a complex biliary tract disease characterized by intrahepatic pigment stones, endemic to South-east Asia and seen with increasing frequency in the United States. The purpose of this study was to review the management of this disorder in a county hospital. METHODS: A retrospective review of 45 patients with recurrent pyogenic cholangitis evaluated between 1984 and 1995. The clinical and surgical management of patients with localized versus bilateral hepatolithiasis were compared. RESULTS: The prevalence of recurrent pyogenic cholangitis at our hospital has more than doubled since 1983. Fourteen of 45 patients (31%) had bilateral disease and required more abdominal computed tomography scans (P <0.01), percutaneous cholangiograms (P <0.05), endoscopies (P <0.01), clinic visits (P <0.05), and hospital admissions (P <0.02) as compared with patients with localized disease. CONCLUSIONS: The effective treatment of recurrent pyogenic cholangitis requires definition of the patients' intrahepatic distribution of disease, prior to surgical intervention, and the coordinated efforts of gastroenterologists, radiologists, and surgeons.
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