Bacteremia in relation to intrabiliary pressure in proximal v. distal malignant biliary obstruction.

Ten patients with proximal malignant biliary obstruction (group A) and ten with distal malignant biliary obstruction (group B) who underwent surgery in 1983-1984 were prospectively studied as regards incidence of bacteremia and its relationship with intrabiliary pressure. The patients with proximal obstruction had higher intrabiliary pressure, associated with higher incidence of bacteremia. The intergroup differences were statistically significant in these respects, which influenced the clinical presentation. In general, the clinical manifestations were more severe in the group A patients. The study indicated that lowering of the intrabiliary pressure is essential for a good outcome in acute cholangitis. This applies particularly to proximal malignant obstruction, in which the intrabiliary pressure tends to be high and rapidly to provoke a dramatic increase in the incidence of bacteremia.