ACUTE CHOLANGITIS WITH OBSTRUCTIVE JAUNDICE DUE TO COMMON BILE DUCT STONES: A TG18-GUIDED EVALUATION

Abstract

Background: Acute cholangitis is a life-threatening condition caused by ascending bacterial infection of the biliary tree. The risk of mortality is high if this condition is not treated promptly with antibiotics and biliary decompression is not achieved with appropriate methods. This paper presents a case of acute cholangitis accompanied by a discussion based on the Tokyo Guideline 2018.

Case: A 48-year-old female patient was diagnosed with acute cholangitis, presenting with right upper quadrant abdominal pain and jaundice that had persisted for two weeks. Physical examination revealed anemic conjunctiva, scleral and generalized jaundice, and a positive Murphy's sign. Laboratory findings showed anemia, leukocytosis, thrombocytopenia, hyperbilirubinemia, and renal dysfunction. A CT scan revealed dilatation of the biliary ducts, multiple cholelithiasis with cholecystitis. The patient was classified as having grade III acute cholangitis. She was administered supportive therapy and definitive treatment, including antibiotics and cholecystectomy. The patient was hospitalized for six days postoperatively and discharged in improved condition.

Conclusion: The management of acute cholangitis involves prompt and accurate diagnosis, determination of severity, and appropriate treatment. Early administration of antibiotics, biliary drainage therapy, and etiological management lead to favorable outcomes.