Introduction
Cholangitis is inflammation of the bile duct. It is typically the results of a bacterial infection (often secondary to gallstones), but can also occur in other conditions, such as primary sclerosing cholangitis and Caroli’s Syndrome. It may also be present in malignancies of the biliary system.
- In cases where bacterial infection is the cause, it is called ascending cholangitis.
Acute Ascending Cholangitis
Has a high mortality and morbidity, especially in old people.
Presentation – rigors, fever, abdominal pain, jaundice
Treatment
It is a medical emergency.
- IV antibiotics – usually cephalosporin- e.g. cefotaxime
- Urgent biliary drainage – Endoscopically – usually access to the biliary tree is gained by sphincterotomy, and then stones removed with a balloon catheter. Successful in 90% of patients.
- In severely ill patients, stenting may be used in place of stone removal, to reduce peri-operative risk whilst still providing drainage. Stones will later be removed via ERCP.
- Surgical drainage carries an extremely high mortality, and is reserved for those with whom endoscopic methods are not effective