ABSTRACT
Acute cholangitis is most commonly a consequence of biliary obstruction followed by bacterial overgrowth within bile itself. Patients with cholangitis may present with a wide variety of symptoms from nonspecific findings to severe infection and fatal septic shock. Morbidity and mortality are minimized only via early diagnosis and treatment. The treatment of acute cholangitis has shown dramatic improvement over the past decade with a current mortality of less than 30%. Patients with grade III cholangitis require admission to the intensive care unit for physiologic support in addition to general medical treatment. Urgent endoscopic, percutaneous, or surgical biliary drainage must also be performed. The specifics of antimicrobial utility and treatment are outlined in the 2018 Tokyo guidelines for acute cholangitis and cholecystitis. Patients with any periampullary malignancy should undergo Endoscopic retrograde cholangio-pancreatography-based stenting as the initial choice.
