Percutaneous biliary drainage: a superior option in select cases of acute cholangitis: a case report

Acute cholangitis is a severe, potentially life-threatening condition, frequently occurring post-ERCP. While endoscopic drainage is the preferred first-line treatment, percutaneous biliary drainage (PTBD) is a crucial alternative in select cases. We present a 55-year-old patient with prior left hemicolectomy and liver metastasis treatment developed acute cholangitis following failed ERCP stent placement, leading to rapid deterioration. Due to high anesthetic risk, ultrasound-guided PTBD with an 8 Fr pigtail catheter was performed under local anesthesia, resulting in significant clinical improvement. Broad-spectrum antibiotics targeted Escherichia coli. The misplaced stent was subsequently replaced, and the patient was discharged on postoperative Day 9 with normalized bilirubin and coagulation. Follow-up confirmed good drain tolerance and recovery. This case underscores PTBD's critical role when endoscopic drainage fails. A multidisciplinary approach and early intervention are essential to improving outcomes in acute cholangitis management.