Akut Kolanjit
Özet
Akut kolanjit, safra kanalı tıkanıklığına ikincil gelişen ve çoğunlukla koledokolitiazis, benign darlıklar veya malignitelerden kaynaklanan hayatı tehdit edici bakteriyel bir safra yolları enfeksiyonudur. Tanı, Tokyo 2018 kılavuzuna (TG18) uygun olarak ateş veya laboratuvarda saptanan lökositoz gibi sistemik inflamasyon belirtileri, hiperbilirubinemi veya karaciğer enzim yüksekliği gibi kolestaz bulguları ve görüntülemede biliyer dilatasyon veya tıkanıklık etiyolojisinin kombine değerlendirilmesiyle konur. Tedavinin temel iki bileşeni olan intravenöz ampirik antibiyoterapi ve biliyer dekompresyon (başlıca ERCP, alternatif olarak EUS kılavuzluğunda drenaj veya PTK) hayati önem taşır. Hafif ve orta vakalar konservatif tedavi ve 24-48 saat içinde planlı drenaja yanıt verebilirken, organ disfonksiyonu ile karakterize ciddi süpüratif kolanjitte 24 saat içinde acil biliyer drenaj hayat kurtarıcıdır. Günümüzde erken tanı, hızlı triaj ve gelişen endoskopik teknikler sayesinde mortalite oranları %10’un altına düşmüştür. Nükslerin önlenmesi için akut atak düzeldikten sonra kolesistektomi veya stent değişimi gibi altta yatan nedenlerin tedavisi mutlaka planlanmalıdır.
Acute cholangitis is a life-threatening bacterial biliary tract infection secondary to bile duct obstruction, most commonly caused by choledocholithiasis, benign strictures, or malignancies. Diagnosis is established based on the Tokyo Guidelines 2018 (TG18) by combining evidence of systemic inflammation (fever, leukocytosis), cholestasis (hyperbilirubinemia, elevated liver enzymes), and imaging findings indicating biliary dilation or the underlying etiology. The cornerstones of management are immediate intravenous empirical antibiotic therapy and timely biliary decompression, primarily via ERCP, or alternatively through EUS-guided drainage or PTK. While mild-to-moderate cases often respond to conservative management followed by scheduled drainage within 24-48 hours, severe suppurative cholangitis characterized by organ dysfunction demands emergent biliary decompression within 24 hours to prevent septic shock. Thanks to advanced diagnostic imaging, rapid triage, and improved endoscopic techniques, overall mortality rates have successfully decreased to below 10%. To prevent recurrence, definitive treatment of the underlying cause, such as elective cholecystectomy or stent management, must be performed after the acute infection resolves.
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