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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
PubMed
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%.

Keywords:
Acute cholangitisEpidemiologyEtiologyManagement

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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%.