Acute cholangitis, also known as ascending cholangitis, is a life-threatening condition caused by an ascending bacterial infection of the biliary tree.Choledocholithiasis is the most common cause, with infection-causing stones in the common bile duct leading to partial or complete obstruction of the biliary system. The diagnosis is made by clinical presentation, abnormal laboratory results, and imaging studies implying infection and biliary obstruction.
Initial medical therapy relies on early fluid resuscitation and appropriate antibiotic coverage. Delay in treatment can lead to septic shock. Depending on the course and severity, a biliary drainage procedure may be performed with the assistance of endoscopic and surgical resources. Acute cholangitis is a treatable condition when managed appropriately. However, mortality can be quite high if there is a significant delay in treatment. There are various types of cholangitis, including primary biliary cholangitis, IgG4-related autoimmune cholangitis, and primary sclerosing cholangitis. By far, the most common is acute bacterial cholangitis and will be the focus of this review article.