Background; Although hepatobiliary and pancreatic (HBP) surgery can be associated with a considerable risk of infectious complications in the perioperative period, little is known about the effect of infectious disease (ID) consultation in this setting. Methods；A retrospective study was conducted to evaluate the practice patterns of ID consultations requested by HBP surgeons at a comprehensive cancer center during a 9-year period. Results; Among 183 patients who underwent ID consultations, 42% had biliary tumors, whereas 33, 23, and 2% had pancreatic, hepatic, and duodenal tumors, respectively. The reasons for the ID consultations were classified into the following three main groups: management of undiagnosed conditions (39%), management of established infections (48%), and management of surgical antimicrobial prophylaxis (14%). Among the management of undiagnosed conditions, the management of fever or elevated inflammatory markers was most frequently requested. Concerning the management of established infections, the most common types of infection were peritonitis or intra-abdominal abscess, followed by cholangitis or liver abscess. Conclusions; The particular knowledge and expertise of ID consultants has been sought, particularly for the selection and duration of antimicrobial agents and also for the differentiation of infectious from non-infectious causes of fever in this population.

Background: Cholangitis, one of the most common complications in patients who undergo pancreaticoduodenectomy (PD), can occasionally turn fatal. However, the risk factors for the development of cholangitis after PD remain unclear. The aim of this study was to investigate the risk factors for cholangitis at our hospital.Methods: We performed a retrospective cohort study including 190 patients who underwent PD at our institution between January 2008 and August 2015. We investigated the relationship between the occurrence of cholangitis requiring hospitalization after PD and other clinicopathological factors. Results: Cholangitis occurred in 22 patients. Using the receiver operating characteristic curve, we calculated the cut-off value as 8.2mm (AUC: 0.6629, sensitivity 0.68, specificity 0.64, Youden index). We observed that a preoperative diameter of the bile duct<8.2mm was significantly correlated with the incidence of cholangitis after PD. No statistically significant correlation was detected between cholangitis and other clinicopathological factors. Conclusion: The present study suggested the possibility that a preoperative bile duct diameter<8.2mm could be a risk factor for cholangitis after PD.

【Background】The efficacy of SBE-ERC in patients with choledochojejunostomy is unkown. 【Method】We investigated retrospectively one hundred thirty seven patients with choledochojejunostomy who underwent hospitalization for acute cholangitis between June 2011 and March 2015. 【Result】The breakdown of treatment was as follows：Antibioticsgroup (n=55: 40.1％), PTBDgroup (n=13:9.5％) and SBE-ERCgroup (n=69: 50.4％). The success rate of reaching the target site was 95.7％ （66 of 69 SBE-ERC procedures） . There was no significant difference between Antibiotics group and SBE-ERC group in severity of cholangitis. The length of hospital stay was significantly shorter in SBE-ERC group 8 (4-28) days than Antibiotics group 13 (3-28) days. 【Conclusion】SBE-ERC revealed the cause of cholangitis in the patients with choledochojejunostomy and could treat the cause at the same time, thus the length of hospital stay was short.

Cholangitis after choledo-jejunostomy (CJS) for pancreaticobiliary disease is an important issue that greatly affects the applicability of chemotherapy and quality of life. We examined cases with postoperative cholangitis which we experienced from 2005 to 2017. Of the patients who had complicated CJS for pancreaticobiliary disease, 34 cases were in need of hospitalization as acute cholangitis, which contained 24 men(average age was 66.8 years), 20 cases of pancreatic disease, 29 cases of malignant disease. For the diagnosis of acute cholangitis, Tokyo Guidelines 2018 was used. The positive rate of blood culture at hospitalization and the bile culture were 52.2％ and 100％. Cholangitis after CJS is need to be treated as healthcare-associated cholangitis, and antibiotic in empiric therapy should be one that can cover multidrug resistant bacteria. In the case of stenosis at the anastomotic site, the balloon dilatation under the small intestine endoscope is useful in recent years.

Pathogens isolated from hepatobiliary infection during 10 years were investigated in a multicenter study in Japan. 508 strains (bacteria and fungi) were obtained from 232 cases. These strains were divided to community-acquired infection (CAI) and postoperativeinfection (POI), and also divided to former 5 years and later 5 years. Among CAI, the isolation rate of Enterococcus spp. was highest and followed by Escherichia coli, Klebsiella spp. and Enterobacter spp.. Among POI, the isolation rate of Enterococcus spp. was the highest, followed by Enterobacter spp. and Bacteroides spp.. Among POI, the rate of Enterococcus spp. in later period was higher than that of former period. About major pathogens, susceptibilities to antimicrobial agents were not getting worse.

Surgical resection is only curative method for the patients of biliary cancer. In these patients, obstructive jaundice and cholangitis may occur due to malignant biliary stricture before surgery. Therefore preoperative biliary drainage should be performed for control of biliary infection and appropriate relief of icterus. It have been reported that preoperative biliary drainage is useful for the patients of perihilar cholangiocarcinoma, however there is still unclear that for patients who are performed pancreaticoduodenectomy. Endoscopic drainage is recommended as the method of preoperative biliary drainage compare with percutaneous transhepatic drainage. Prophylactic antimicrobial agents are selected according to the results of a drug susceptibility test of a surveillance of preoperative bile culture because concordance rate between bile juice culture before surgery and bacterial culture from surgical site infection is very high. Comprehension of merits and demerits of preoperative biliary drainage, proper selection of method of drainage, and treatment strategy according to a surveillance of preoperative bile culture, are important for safety surgery for biliary cancer avoiding infectious complication.

Obstructive jaundice is the most common symptom in patients with periampullary diseases. Preoperative biliary drainage (PBD) has been conventionally performed for relieving biliary obstruction, prior to pancreaticoduodenectomy (PD). It has been reported that the patients who underwent PBD, had positive bile culture at the time of PD, resulting in postoperative infectious complications. In this report, we review the PBD prior to PD, and correlations between preoperative biliary infections and postoperative pancreatic fistula.

Herein, we present the case of three patients with bile leak after hepatectomy and postoperative biliary infection who were treated with interventional radiology (IVR). Case 1 was a patient with bile leak at the origin of the anterior segmental bile duct after hepatectomy. Endoscopic biliary drainage could not be inserted owing to large abscess formation. Therefore, a percutaneous drainage tube was inserted into the injured bile duct, after which an endoscopic biliary stent (EBS) could be inserted. Case 2 was a patient with bile leak after hepatectomy. An EBS could not be inserted owing to stenosis at the origin of the B5 biliary branch. Therefore, percutaneous biliary drainage tubes were inserted both upstream and downstream, after which an EBS could be inserted. Case 3 was a patients who developed liver abscess and severe biliary infection owing to stenosis of the right hepatic duct after hepaticojejunostomy. Percutaneous posterior biliary duct drainage was performed. Double balloon endoscopic biliary drainage tube could not be inserted. Therefore, PTBD support was performed using a guidewire support, thereby allowing insertion of the EBS. Furthermore, EBS could be inserted precisely and safely using IVR support.