Acute cholangitis

Abstract

A severe complication of biliary obstruction is acute cholangitis. Acute cholangitis is mostly caused by common bile duct stones; less frequent causes are benign or malignant biliary strictures. Typical signs and symptoms are abdominal pain, fever, and jaundice (Charcot’s triad). In elderly or in immunocompromised patients, typical clinical criteria may be missing. Diagnosis may be difficult when cholecystitis coexists. Cholangitis is life-threatening when it progresses to sepsis and multiple organ failure. First-line treatment includes general supportive measures such as adequate intravenous hydration and empiric antibiotic treatment. The severity of cholangitis depends on signs of sepsis and organ dysfunction. Patients with moderate and severe cholangitis require early biliary drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is the first choice. If the patient is not stable or if ERCP is not possible, a percutaneous approach should be chosen. This chapter describes diagnostic steps, severity assessment of cholangitis, and treatment algorithms.