Clinical Research
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2005; 11(27): 4199-4205
Published online Jul 21, 2005. doi: 10.3748/wjg.v11.i27.4199
Sclerosing cholangitis following severe trauma: Description of a remarkable disease entity with emphasis on possible pathophysiologic mechanisms
Johannes Benninger, Rainer Grobholz, Yurdaguel Oeztuerk, Christoph H. Antoni, Eckhart G. Hahn, Manfred V. Singer, Richard Strauss
Johannes Benninger, Yurdaguel Oeztuerk, Eckhart G. Hahn, Richard Strauss, Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, Erlangen D-91054, Germany
Christoph H. Antoni, Manfred V. Singer, Department of Medicine II, Ruprecht-Karls-University Heidelberg, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim D-68135, Germany
Rainer Grobholz, Department of Pathology, Ruprecht-Karls-University Heidelberg, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim D-68135, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Johannes Benninger, Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, Erlangen D-91054, Germany. johannes.benninger@med1.imed.uni-erlangen.de
Telephone: +49-9131-85-35204 Fax: +49-9131-85-209
Received: August 26, 2004
Revised: September 3, 2004
Accepted: September 6, 2004
Published online: July 21, 2005
Abstract

AIM: Persistent cholestasis is a rare complication of severe trauma or infections. Little is known about the possible pathomechanisms and the clinical course.

METHODS: Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma (one burn injury, three accidents, one power current injury). Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.

RESULTS: Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis (PSC)-like destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up >2 years. Therapeutic possibilities were limited.

CONCLUSION: Posttraumatic sclerosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension. Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.

Keywords: Life-threatening trauma; Arterial hypotension; Cholestasis; Ischemia of intrahepatic bile ducts; Secondary sclerosing cholangitis; Posttraumatic sclerosing cholangitis