Cholangiohepatitis: Radiological spectrum of the disease amid the rising prevalence in india: A case study in a tertiary institute in South India

Introduction: There is a rising incidence of Oriental cholangiohepatitis (OCH) also known as recurrent pyogenic cholangitis (RPC), in Indian population. The condition which presents with classical triad of recurrent upper abdominal pain, obstructive jaundice and fever is characterized by biliary sludge, intrahepatic bile duct calculi, strictures, duct dilatation and cholangitis resulting from chronic biliary parasitic infestation and associated chronic secondary portal bacteremia. Aim: The purpose of this retrospective study was to understand the spectrum of radiological manifestations of oriental cholangiohepatitis by MRI which helps in differentiating it from other differential causes of biliary obstruction and cholangitis. Materials and Methods: This was a retrospective study of cases of oriental pyogenic cholangitis diagnosed by MRI over a period of 3 years in department of radio diagnosis who were referred from gastroenterology department with clinical suspicion of cholangitis and diagnosed as having OCH based on MRI finding’s and later confirmed by ERCP or biochemical parameters. Results: Out of the total 950 MRCP scans evaluated, 150 cases were of suspected cholangitis and only 9 cases had features of oriental pyogenic cholangitis. These patients showed the characteristic MRCP finding’s like ductal changes including intraductal calculi with dilatation and strictures in RHD and LHD, segmental and subsegmental IHBRs and in extrahepatic biliary tree i.e. CHD and CBD with decreased arborization of peripheral biliary radicals; wall thickening in biliary tree and pneumobilia; and parenchymal abnormalities like fatty liver, hepatomegaly, segmental atrophy or diffuse liver atrophy. Complications like portal hypertension, splenomegaly and ascites that occur were also observed. Though literature mentions complications like hepatic mass/SOL i.e. hepatic abscess or malignancy, we didn’t have any in our case series. Conclusion: To summarise, presence of hepatolithiasis and choledocholithiasis with significant biliary duct dilatation and short segment strictures in the biliary tree with peripheral IHBR pruning, usually in the absence of gallstones on MRCP is nearly pathognomonic of oriental pyogenic cholangitis in patients presenting with classical clinical triad of abdominal pain, jaundice and fever and obviates the need for diagnostic ERCP.