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Acute cholangitis: Diagnosis and management
A Sokal1, A Sauvanet2, B Fantin3
1Internal medicine unit, hôpital Beaujon, Assistance-publique des Hôpitaux de Paris, 92110 Clichy, France.
Journal of Visceral Surgery
|June 29, 2019
Summary
Acute cholangitis, a bile duct infection often caused by obstruction, requires prompt diagnosis using Tokyo Guidelines. Treatment involves antibiotics and biliary drainage, though mortality remains around 5%.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Hepatology
Background:
- Acute cholangitis is a biliary tract infection, frequently resulting from obstruction like choledocholithiasis or neoplasia.
- Diagnosis traditionally used Charcot's triad, but the Tokyo Guidelines (2007) introduced a more sensitive score incorporating clinical, biological, and radiological data.
Purpose of the Study:
- To review the diagnosis, management, and outcomes of acute cholangitis.
- To highlight the importance of timely and accurate diagnostic methods and effective treatment strategies.
Main Methods:
- Review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and CT scans.
- Emphasis on bacteriological sampling (blood and bile cultures) for pathogen identification.
- Discussion of antimicrobial therapy and biliary drainage procedures.
Main Results:
- Imaging: Ultrasound has limitations, MRCP and EUS offer excellent diagnostic capacity, CT is intermediate.
- Microbiology: Escherichia coli and Klebsiella spp. are common pathogens; Enterococcus and anaerobic coverage are debated.
- Risk Factors: Biliary stents are linked to multidrug-resistant infections.
Conclusions:
- Acute cholangitis necessitates a combination of appropriate antimicrobial therapy and biliary drainage.
- Despite advances, the condition carries a significant mortality rate of approximately 5%.
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