Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Acute Cholangitis without Biliary Obstruction: Causes and Radiologic Features

담관의 막힘이 없는 급성담관염의 원인과 영상분석

  • Jo, Jung-Hyun (Department of Radiology, Dong-A University, College of Medicine) ;
  • Kwon, Hee-Jin (Department of Radiology, Dong-A University, College of Medicine) ;
  • Kang, Myong-Jin (Department of Radiology, Dong-A University, College of Medicine) ;
  • Yoon, Seong-Kuk (Department of Radiology, Dong-A University, College of Medicine) ;
  • Cho, Jin-Han (Department of Radiology, Dong-A University, College of Medicine)
  • 조정현 (동아대학병원 영상의학과) ;
  • 권희진 (동아대학병원 영상의학과) ;
  • 강명진 (동아대학병원 영상의학과) ;
  • 윤성국 (동아대학병원 영상의학과) ;
  • 조진한 (동아대학병원 영상의학과)
  • Received : 2009.08.29
  • Accepted : 2009.10.17
  • Published : 2010.06.01
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Abstract

Purpose: The aim of this study is to determine the causes of acute cholangitis without the biliary obstruction and radiological findings. Materials and Methods: This study was performed retrospectively. A total of 135 patients diagnosed with acute cholangitis in a clinical setting based on the review of the radiologic findings from an ultrasonogram (USG), computed tomogram (CT), or magnetic resonance images (MRI). Among them, patients with a biliary obstruction as a result of a stone, tumor, lymph node, stricture were excluded. A total of 31 patients had acute cholangitis without a definite biliary obstruction. We analyzed their causes and imaging features with the USG and CT image. Results: The causes of acute cholangitis without biliary obstruction included Clonorchis sinensis cholangitis in 15 cases (48%), post-operative swelling after gastrojejunostomy, pylorus preserved partial duodenectomy, and choledochojejunostomy in 7 cases (22.6%), recent spontaneous passage of a distal CBD stone in 3 cases (9.7%), compression effect by the large duodenal diverticulum in 2 cases (6.5%), and unknown causes in 4 cases (12.9%). Conclusion: Acute cholangitis may be associated without a distal biliary obstruction. USG, CT, or MR imaging can provide precise information as well as help to differentiate the causes of acute cholangitis.

목적: 담관의 막힘이 없이 발생한 급성담관염의 원인과 영상소견을 알아보고자 하였다. 대상과 방법: 최근 1년간 임상적 소견과 초음파를 시행하고 전산화단층촬영과 자기공명영상 중 1가지 이상을 촬영하여 급성담관염으로 진단된 환자 135명의 환자를 대상으로 후향적으로 분석하였다. 환자를 담도 막힘이 있는 경우와 없는 경우의 두 군으로 나누었으며 이중 결석, 종양, 림프선 비대, 협착 등의 담도 막힘이 있는 경우를 제외한 나머지 31명의 환자를 대상으로 하여 원인을 분류하고 영상의학적 검사 소견을 분석하였다. 결과: 담도 막힘이 없는 급성담관염이 발생한 31명의 환자 중 간디스토마로 진단된 경우가 15예, 위공장문합술 후 부종, 위유문보존 췌.십이지장 절제술, 총담관 공장문합술을 포함한 상복부 수술 후 발생한 경우가 7예, 총수담관 담석의 자연배설 직후가 3예, 십이지장 팽대부 주위 게실이 2예였으며, 원인을 찾을 수 없었던 경우가 4예였다. 결론: 급성담관염의 일부는 원위부 담도의 막힘이 없이도 발생할 수 있다. 이러한 경우 전산화 단층촬영술 혹은 자기공명영상과 초음파소견으로 그 원인을 추론할 수 있다.

Keywords

Acknowledgement

Supported by : 동아대학교

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