Agustos 2011
Primer sklerozan kolanjit benzeri kolanjiyograma sahip hastalarin degerlendirilmesi
The evaluation of patients with primary sclerosing cholangitis-like cholangiogram
- Ana Sayfa
- Sayılar
- Agustos 2011
- Primer sklerozan kolanjit benzeri kolanjiyograma sahip hastalarin degerlendirilmesi...
Özet
Primer sklerozan kolanjit benzeri kolanjiyograma neden olan durumlar; safra yollarinda obstrüktif, toksik, iskemik patolojilere neden olan durumlar ve neoplastik hastaliklar olarak sayilabilir. Biz burada primer sklerozan kolanjit benzeri kolanjiyograma sahip 14 olguya ait verileri sunmayi amaçladik. Gereç ve Yöntem: Ocak 2006 Kasim 2010 yillari arasinda klinigimizce takip edilen veya endoskopik retrograd kolanjiyopankreatografi ünitemize degerlendirme amaçli gönderilen primer sklerozan kolanjit benzeri kolanjiyograma sahip 14 hastaya ait bulgular ve seyir degerlendirildi. Bulgular: Hastalarin ortalama yasi 56.36±15.93 idi ve 5’i (%36) kadindi. 12 hastada (%86) altta yatan malignite söz konusu iken (karacigere metastaz yapmis diger organlara ait malignitesi olan 9 hasta ve primer hepatobiliyer sistem malignitesi olan 3 hasta) diger 2 hastanin birinde tüberküloza bagli granülomatöz hepatit, digerinde ise biliyer sistem tutulumunun da eslik ettigi sistemik Exophiala dermatitidis enfeksiyonu söz konusuydu. Tüm hastalarin 11’inde (%78.5) temel bulgu ikter iken, bunlarin 5’inde iktere agri ve/veya kasinti eslik ediyordu. Iki hastada ise malignite söz konusu olup bunlarda yalnizca kan biyokimyasinda ve ultrasonografik degerlendirmede kolestaz lehine bulgular saptanmisti. Kolanjit ile basvuran yalnizca bir hasta mevcuttu ve bu hastaya sistemik mantar enfeksiyonu tanisi konulmustu. Primer sklerozan kolanjit benzeri kolanjiyogram saptanan tüm hastalara endoskopik retrograd kolanjiyografi ile endoskopik biliyer drenaj tedavileri denenmisti. Malignitesi olan hastalarin 7’si (%58.3) endoskopik girisim sonrasi kolanjit ve buna sekonder gelisen septik komplikasyonlarla kaybedilirken, tüberküloz ve Exophiala dermatitidis enfeksiyonu olan hastalarda altta yatan hastaligin medikal tedavisi ile kontrol kolanjiogramlarinda belirgin düzelme gözlendi. Sonuç: Sonuçlarimiza göre primer sklerozan kolanjit benzeri kolanjiyogramli hastalarin büyük çogunlugunu, karacigere metastaz yapmis diger organ malignitelerine sahip hastalar olusturmaktadir. Karacigere, primer sklerozan kolanjit benzeri kolanjiograma neden olacak sekilde metastaz yapmis veya primer hepatobiliyer maligniteli olgularda, endoskopik retrograd kolanjiyografi araciligiyla yapilacak endoskopik drenaj tedavileri tabloyu daha da kötülestirebilir. Öncelikle drenaja en uygun safra kanalinin saptanmasi açisindan manyetik rezonans kolanjio- pankreatografik inceleme uygun olabilir.
Abstract
The conditions causing primary sclerosing cholangitis-like cholangiogram are pathologies of the biliary tract due to obstructive, ischemic or toxic events and neoplastic diseases. We aimed to discuss the data of 14 patients with primary sclerosing cholangitis-like cholangiogram in this report. Materials and Methods: In this report, the demographic, clinical and follow-up data of the patients with primary sclerosing cholangitis-like cholangiogram who were either followed in our clinic or were referred to our endoscopic retrograde cholangiopancreatography unit for further investigation between January 2006 and November 2010 are evaluated. Results: The mean age of the 14 patients was 56.36±15.93 years, and 5 (36%) were female. In 12 patients (86%), the underlying causes of the pathology were malignancies with liver metastases; in the remaining 2 patients, the causes were granulomatous hepatitis secondary to tuberculosis (n: 1) and systemic Exophiala dermatitidis infection with biliary involvement (n: 1). In 11 (78.5%) of the patients, the main symptom was icterus, and in 5 of these patients, pruritus and/or pain was accompanying. In 2 patients with malignancy, only biochemical analysis and ultrasonographic findings revealed cholestasis. One patient referred with cholangitis was diagnosed as systemic fungal infection. In all patients with primary sclerosing cholangitis-like cholangiogram, endoscopic biliary drainage was attempted by endoscopic retrograde cholangiography. After endoscopic approach, 7 (58.3%) of the patients with underlying malignancy died due to cholangitis and secondary septic complications, but in the patients with tuberculosis and Exophiala dermatitidis infection, follow-up cholangiograms revealed improvement with medical therapy of the underlying diseases. Conclusions: In patients with liver metastases causing primary sclerosing cholangitis-like cholangiogram, endoscopic drainage by endoscopic retrograde cholangiography worsens the clinical condition. In order to determine the optimal biliary duct suitable for drainage, magnetic resonance cholangiopancreatographic evaluation should be performed. The underlying disease should be treated whatever the cause.
