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Órgano Oficial de la Asociación Mexicana de Hepatología

2015, Number 5

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Ann Hepatol 2015; 14 (5)

Secondary sclerosing cholangitis following major burn

Ben-Ari Z, Levingston D, Weitzman E, Haviv-Yadid Y, Cohen-Ezra O, Weiss P, Zuckerman E, Inbar Y, Amitai M, Rimon U, Goder M, Jaik H

Language: English
References: 14
Page: 695-701
PDF size: 267.06 Kb.


ABSTRACT

Background and aims. Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a relatively new previously unrecognized entity which may lead to severe biliary disease with rapid progression to cirrhosis. We present for the first time a case series of patients with rapidly progressive SSC-CIP requiring aggressive intensive care treatment following major burn injury. Results. SSC-CIP was diagnosed in 4 consecutive patients hospitalized due to major burn injuries at our Intensive Care Unit (ICU). SSC-CIP was diagnosed when ERCP (n = 1) or MRCP (n = 3) demonstrated irregular intrahepatic bile ducts with multiple strictures and dilatations and, when a liver biopsy (n = 3) demonstrated severe cholestasis and bile duct damage. All patients were males; none of whom had pre-existing liver disease. Ages: 18-56 y. All patients suffered from severe (grade 2-3) burn injuries with total burn surface area ranging from 35 to 95%. Mean length of ICU hospitalization was 129.2 ± 53.0 days. All patients required mechanical ventilation (with a mean PEEP of 8.4 ± 2.1 cm H2O) and the administration of catecholamines for hemodynamic stabilization. All patients demonstrated severe cholestasis. Blood cultures and cultures from drained liver abscesses grew hospital acquired multiple resistant bacteria. Liver cirrhosis developed within 12 months. One patient underwent orthotopic liver transplantation. Two patients (50%) died. In conclusion, SSC-CIP following major burn injury is a rapidly progressive disease with a poor outcome. Liver cirrhosis developed rapidly. Awareness of this grave complication is needed for prompt diagnosis and considerations of a liver transplantation.


REFERENCES

  1. Ruemmele P, Hofstaedter F, Gelbmann CM. Secondary sclerosing cholangitis. Nat Rev Gastroenterol Hepatol 2009; 6: 287-95.

  2. Batts KP. Ischemic cholangitis. Mayo Clin Proc 1998; 73: 380-5.

  3. Gelbmann CM, Rummele P, Wimmer M, Hofstädter F, Göhlmann B, Endlicher E, Kullmann F, et al. Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients. Am J Gastroenterol 2007; 102: 1221-9.

  4. Engler S, Elsing C, Flechtenmacher C, Theilmann L, Stremmel W, Stiehl A. Progressive sclerosing cholangitis after septic shock: a new variant of vanishing bile duct disorders. Gut 2003; 52: 688-93.

  5. Benninger J, Grobholz R, Oeztuerk Y, Antoni CH, Hahn EG, Singer MV, Strauss R. Sclerosing cholangitis following severe trauma: description of a remarkable disease entity with emphasis on possible pathophysiologic mechanisms. World J Gastroenterol 2005; 11: 4199-205.

  6. Jaeger C, Mayer G, Henrich R, Gossner L, Rabenstein T, May A, Guenter E, et al. Secondary sclerosing cholangitis after long-term treatment in an intensive care unit: clinical presentation, endoscopic findings, treatment, and follow- up. Endoscopy 2006; 38: 730-4.

  7. Lin T, Qu K, Xu X, Tian M, Gao J, Zhang C, Di Y, et al. Sclerosing cholangitis in critically ill patients: an important and easily ignored problem based on a German experience. Front Med 2014; 8: 118-26.

  8. Al-Benna S, Willert J, Steinau HU, Steinstraesser L. Secondary sclerosing cholangitis, following major burn injury. Burns 2010; 36: e106-e110.

  9. Voigtländer T, Negm AA, Schneider AS, Strassburg CP, Manns MP, Wedemeyer J, Lankisch TO. Secondary sclerosing cholangitis in critically ill patients: model of end-stage liver disease score and renal function predict outcome. Endoscopy 2012; 44: 1055-8.

  10. Esposito I, Kubisova A, Stiehl A, Kulaksiz H, Schirmacher P. Secondary sclerosing cholangitis after intensive care unit treatment: clues to the histopathological differential diagnosis. Virchows Arch 2008; 453: 339-45.

  11. Kulaksiz H, Heuberger D, Engler S, Stiehl A. Poor outcome in progressive sclerosing cholangitis after septic shock. Endoscopy 2008; 40: 214-8.

  12. Putensen C, Wrigge H, Hering R. The effects of mechanical ventilation on the gut and abdomen. Curr Opin Crit Care 2006; 12: 160-5.

  13. Krejci V, Hiltebrand LB, Sigurdsson GH. Effects of epinephrine, norepinephrine, and phenylephrine on microcirculatory blood flow in the gastrointestinal tract in sepsis. Crit Care Med 2006; 34: 1456-63.

  14. Woolsey CA, Coopersmith CM. Vasoactive drugs and the gut: is there anything new? Curr Opin Crit Care 2006; 12: 155-9.




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