Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It is also referred to as ascending cholangitis. Cholangitis was first described by Charcot as a serious and life-threatening illness; however, it is now recognized that the severity can range from mild to life-threatening .
This topic will review the clinical features, diagnosis, and management of acute cholangitis. The approach to patients with primary sclerosing cholangitis, the management of common bile duct stones, and the endoscopic management of malignant biliary obstructions are discussed in detail elsewhere. (See "Clinical manifestations and diagnosis of primary sclerosing cholangitis" and "Treatment of primary sclerosing cholangitis" and "Endoscopic management of bile duct stones: Standard techniques and mechanical lithotripsy" and "Endoscopic stenting for malignant pancreaticobiliary obstruction".)
Acute cholangitis is caused primarily by bacterial infection in a patient with biliary obstruction. The organisms typically ascend from the duodenum; hematogenous spread from the portal vein is a rare source of infection .
The most important predisposing factor for acute cholangitis is biliary obstruction and stasis. The most common causes of biliary obstruction in patients with acute cholangitis are biliary calculi (28 to 70 percent), benign stenosis (5 to 28 percent), and malignancy (10 to 57 percent) (picture 1) .
Mechanism of bacterial entry into the biliary tract — Bacteria are able to enter the biliary tract when the normal barrier mechanisms are disrupted. This may result in translocation of bacteria from the portal system or duodenum into the biliary tree.