Secondary sclerosing cholangitis following major burn



Título del documento: Secondary sclerosing cholangitis following major burn
Revista: Annals of hepatology
Base de datos: PERIÓDICA
Número de sistema: 000391013
ISSN: 1665-2681
Autors: 1
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Institucions: 1Sheba Medical Center, Tel Aviv. Israel
2Carmel Medical Center, Liver Unit, Haifa. Israel
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Període: Sep-Oct
Volum: 14
Número: 5
Paginació: 695-701
País: México
Idioma: Inglés
Tipo de documento: Estadística o encuesta
Enfoque: Analítico
Resumen en inglés 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
Disciplines Medicina
Paraules clau: Diagnóstico,
Gastroenterología,
Colangitis esclerosante,
Cirrosis,
Quemaduras,
Complicaciones
Keyword: Medicine,
Diagnosis,
Gastroenterology,
Sclerosing cholangitis,
Cirrhosis,
Burns,
Complications
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