Recurrent Pyogenic Cholangitis: Got Stones?

Excerpt

A 48-year-old Vietnamese woman was initially evaluated for a history of recurrent abdominal pain lasting several months. She recalled that at age 16, while residing in Vietnam, she had been diagnosed with “worms in her bile ducts” and she was treated medically. After immigrating to the USA in her twenties, she had experienced bouts of severe abdominal pain associated with fever and chills every 2–3 years; since these episodes were largely self-limited, she had not sought medical attention. The same pain had recently recurred, becoming more persistent. At presentation, laboratory evaluation revealed relatively normal liver function tests, including a total bilirubin of 0.8 mg/dL, aspartate aminotransferase (AST) 50 U/L, alanine aminotransferase (ALT) 73 U/L, and a mildly elevated alkaline phosphatase level of 179 U/L. Abdominal ultrasonography revealed a 5-cm complex echogenic mass near the porta hepatis; a computed tomography (CT) scan demonstrated multiple stones and intrahepatic biliary dilatation limited to the left hepatic lobe. …