Cholangitis is a dangerous form of infection, which affects the bile duct. If untreated, it may have a sudden and severe course and it may endanger the patient's life.


The cause is usually an obstruction of the bile ducts, which causes disruption of bile outflow. Accumulating bile may be easily infected with bacteria, causing the dangerous infection. The obstruction of the bile duct is most commonly caused by a gallstone, which migrates into the duct from the gallbladder. This situation also causes classic biliary colic manifesting with sudden and strong abdominal pain located in the right upper quadrant. However, the condition may be caused even by other malignant diseases blocking the bile duct such as tumors of the biliary tract, liver cancer, pancreatic cancer and gallbladder cancer. Scarring and narrowing of the bile duct may occur also result from ERCP procedure, recurring cholangitis or from certain autoimmune disease known as primary sclerosing cholangitis.


Cholangitis usually has dramatic manifestations including strong abdominal pain located in the upper right abdominal quadrant, loss of appetite, nausea, vomiting, high fever and chills. When the disruption of bile flow lasts for a longer time, it may be accompanied with jaundice, pale stool and dark urine. Sometimes (rather in the elderly people), the symptoms may be rather inconspicuous and manifest just with indeterminate abdominal pain and loss of appetite. However, the overall condition may suddenly deteriorate into sepsis and circulatory shock.


The patient should be carefully examined including physical examination focused on the abdomen. Blood tests confirm increased number of white blood cells, elevated CRP and elevated liver tests. At least a basis abdominal ultrasound should be performed to visualize any obstruction of the bile duct. When there is present a gallstone, ERCP should be done. ERCP is both diagnostic and therapeutic method, which can remove the gallstone and allow the outflow of bile.


Treatment of acute cholangitis is rather conservative. It usually requires hospitalization, bed rest, strict diet, adequate hydration and administration of antibiotics. ERCP may solve obstruction by removing a gallstone or insert a tube-shaped stent to keep the bile duct open. If the obstruction can not be solved by ERCP, it is possible to access the biliary tract by a needle through the skin under X-ray control to ensure bile outflow.

If the situation is present in a patient with positive finding of gallstones in gallbladder, it is advisable to indicate cholecystectomy.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources