Acute cholangitis: current concepts

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Acute cholangitis is a potentially life‐threatening systemic condition characterized by an infection of the bile, which is normally sterile, and biliary obstruction. This condition was first described in 1877 by Charcot as having a triad of right upper abdominal pain, fever and jaundice (Charcot's triad).1 The diagnosis of acute cholangitis is made based on clinical presentation, laboratory results and diagnostic imaging. If acute cholangitis is not recognized early and treated appropriately, it can quickly develop into systemic inflammatory response syndrome (SIRS), sepsis and mortality. Acute cholangitis carried a mortality rate of more than 50%2 in the 1970s and less than 7% in the 1980s.4 Severe acute cholangitis had a mortality rate of between 11 and 27% in the 1990s.6 Early treatment with intravenous antibiotics and biliary decompression with drainage is fundamental in the management of acute cholangitis.
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