Classification and Management of Acute Cholangitis

Marcelo AF Ribeiro Jr, Riham A Affan, Ahmed W Noureldin
2022 Panamerican Journal of Trauma, Critical Care & Emergency Surgery  
the search using specific conditions (and, in, and or). In an effort to highlight the most recent research, a date filter was applied to include papers after 2007 up until August 2022. Additional relevant papers were identified through reference lists of those articles and citation searching in Google Scholar for in-depth evaluation. The total number of articles was 982. Following primary exclusion criteria such as languages other than English, lack of access to a paper, or irrelevance to the
more » ... bject of AC, case reports, commentaries, abstracts, and duplicate removal, we included a total of 172 papers composed of peer-reviewed articles related to the pathophysiology of AC, classification, and management in randomized controlled trials, case-control studies, cohort studies evaluating management guidelines, investigations, novel laboratory markers, and methods of management. After the final analysis, we selected 60 papers. IntroductIon Acute cholangitis (AC), also known as ascending cholangitis, is an urgent medical illness brought on by a bacterial infection of the biliary system, with the common bile duct (CBD) obstruction being the primary cause of the majority of cases. 1 Multiple mechanisms lead to partial or complete biliary obstruction, each with different underlying risk factors contributing to AC morbidity and mortality. 2 Choledocholithiasis, which causes obstruction of the biliary tree, is the most significant risk factor for AC, representing almost 50% of cases. 3 Malignant obstruction, which accounts for 10-30% of cases of AC, is the second most frequent cause of biliary obstruction. 4 AC can also develop after intervention via endoscopic retrograde cholangiopancreatography (ERCP) for different biliary diseases, with a 0.5-2.4% postprocedure incidence rate. 5, 6 Biliary stenting following ERCP also leads to stent-associated cholangitis (SAC) at a rate of 3.5-48.8% due to stent occlusion. 7 The risk of SAC also increased with length, size, and the number of stents placed. 8 Anatomic variations in patients, including multiple and hilar strictures, increase the risk of SAC and are associated with earlier onset of cholangitis. In patients with malignant biliary obstruction, the risk of SAC was 15.6%. 9 The overall current mortality rate of AC is estimated at 5-7.2% following the addition of biliary decompression via ERCP to therapy along with fluid resuscitation and antibiotics. 10 lassic clinical signs of AC include Charcot's triad of fever, jaundice, and right upper quadrant abdominal pain; in late presentation, patients may sustain the Reynolds' pentad that adds to Charcot's triad signs of shock (hypotension and tachycardia) and an altered mental status. 2 However, Charcot's triad is said to have a specificity of over 90% and a sensitivity of about 36%, limiting its use as a diagnostic tool for AC. 11 The gold standard for biliary drainage in AC is biliary decompression via ERCP, but alternative percutaneous and surgical methods exist. 12 MaterIals a n d Methods
doi:10.5005/jp-journals-10030-1401 fatcat:josbsxznyfdlpflcrk6hw6hdnq