Acute cholangitis in the intensive care unit

Abstract

Acute cholangitis is an infection of the biliary tract caused by an obstruction of bile flow leading to bacterial proliferation. The most common cause is lithiasis, followed by tumors and biliary prosthesis dysfunctions. While Charcot's triad (pain, fever, jaundice) is specific for cholangitis diagnosis, it has been replaced by the more sensitive Tokyo guidelines, which include clinical, biological (inflammatory syndrome, liver function abnormalities), and radiological signs. Abdominal ultrasound and CT scan are first-line imaging examinations. Blood cultures and bile cultures are routinely performed. Assessing severity is crucial, as organ failure, defining grade III cholangitis, worsens prognosis and should prompt urgent treatment that includes: (1) antibiotics to initially cover Gram-negative bacilli, with enterococci and anaerobes considered in some cases; (2) bile drainage via endoscopic or radiological means. Complications of either cholangitis or its therapeutic interventions (abscess, pancreatitis, bleeding) aggravate the prognosis, with a mortality rate of 30% for patients admitted to the intensive care unit.