Acute Cholangitis

Overview

Acute cholangitis is a potentially life-threatening infection of the bile ducts, usually caused by a blockage (most often a gallstone) that allows bacteria to multiply. It classically presents with the triad of fever, jaundice, and right upper abdominal pain (Charcot's triad). Prompt biliary drainage and antibiotics are essential — severe cases can rapidly progress to sepsis and organ failure.

Causes

• Common bile duct stones (most frequent cause)
• Bile duct strictures (benign or malignant)
• Blocked biliary stents
• Tumors obstructing the bile duct
• Post-ERCP infection
• Parasitic infections of the biliary tree

Risk Factors

• History of gallstones
• Previous bile duct surgery or ERCP
• Biliary strictures
• Elderly age
• Diabetes and immunosuppression

Symptoms

Diagnosis

• Blood tests (raised white cells, bilirubin, and liver enzymes)
• Blood cultures
• Ultrasound abdomen (dilated bile ducts)
• MRCP (magnetic resonance cholangiopancreatography)
• CT abdomen
• ERCP (both diagnostic and therapeutic)

Treatment Options

Surgical Treatment

Recovery

With timely drainage and antibiotics, most patients improve within 48–72 hours. Definitive treatment of the underlying cause (stone removal, cholecystectomy) follows once stable. Severe cases requiring ICU care take longer. Regular follow-up prevents recurrence.

Prevention

• Timely treatment of gallstones
• Regular replacement of biliary stents when in place
• Prompt evaluation of jaundice
• Cholecystectomy after an episode of stone-related cholangitis

Frequently Asked Questions