Factors in management of acute cholangitis

Ninety episodes of acute cholangitis in 66 patients have been analyzed. In 71% of the episodes, an operation was performed. Eight deaths occurred, for a patient mortality rate of 12%. Sixty-seven per cent of the operations were performed after at least 72 hours of antibiotic therapy, whereas only 17% had to be done as life-threatening emergencies within 24 hours of admission to the hospital. Although 86% of the operative deaths occurred in the group operated on more than 72 hours after admission, this was not statistically significant. However, death did correlate with failure to respond to antibiotic therapy (p less than 0.001) irrespective of time of operation. Biliary cancer and congenital lesions were etiologic for 31% of the operative cases in this series, but were responsible for 71% of the postoperative deaths (p less than 0.05). We conclude that acute cholangitis has a wide spectrum of severity and that most cases will respond to antibiotic therapy, affording the surgeon the luxury of operating in an elective fashion. Moreover, acute cholangitis complicated by failure to respond to antibiotic therapy is more likely to occur in biliary cancer and congenital lesions, and subsequently will have a poorer prognosis.