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Acute Cholangitis

Biliary Tract Infection — Charcot Triad, Tokyo Guidelines, and Urgent Drainage

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Acute Cholangitis?

Acute cholangitis results from bacterial infection superimposed on partial or complete biliary obstruction, most commonly from choledocholithiasis, biliary strictures, or malignant obstruction.

Common pathogens include E. coli, Klebsiella, Enterococcus, and Enterobacter; severity ranges from mild to life-threatening septic shock.

Diagnosis uses Tokyo Guidelines 2018: systemic inflammation plus cholestasis plus imaging evidence of biliary obstruction.

Severity grading: Grade I (mild), Grade II (moderate), Grade III (severe with organ dysfunction).

Symptoms

Charcot triad: fever with rigors, jaundice, right upper quadrant pain
Reynolds pentad (severe): Charcot triad plus hypotension and altered mental status
Nausea, vomiting, and dark urine
Pruritus and pale stools from biliary obstruction
Septic shock with multiorgan dysfunction in severe cases
Hyperbilirubinemia, alkaline phosphatase elevation, and leukocytosis

Risk Factors

Choledocholithiasis (most common cause)
Benign or malignant biliary strictures
Prior biliary instrumentation (ERCP, surgery)
Biliary stents (occlusion)
Pancreatic, ampullary, or bile duct cancer
Parasitic infections (Ascaris, liver flukes) in endemic areas

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Fever with jaundice and abdominal pain — emergency evaluation
  • Known biliary disease with new fever or worsening symptoms
  • Signs of severity: hypotension, confusion, respiratory distress

Treatment Methods

01
Initial resuscitation: IV fluids, oxygen, electrolyte correction, and sepsis bundle adherence
02
Empiric broad-spectrum antibiotics within 1 hour: piperacillin-tazobactam, ceftriaxone plus metronidazole, or carbapenem for severe cases
03
Urgent biliary decompression — ERCP within 24 hours (preferred) for stone removal and/or stent placement
04
Percutaneous transhepatic biliary drainage (PTBD) or surgical drainage when ERCP fails or is contraindicated
05
ICU admission for Grade III cholangitis; vasopressors and organ support as needed
06
Elective cholecystectomy after recovery for gallstone etiology; address underlying stricture or malignancy

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.