Ascending cholangitis

Acute cholangitis - also known as ascending cholangitis - is acute inflammation and infection of the biliary tract.

The onset of acute cholangitis requires 2 factors

• bile stasis due to chronic obstruction,
  • choledocholithiasis causes up to 80% of cases of acute cholangitis
• bacterial growth in bile

Not all obstructing lesions are followed by biliary infection

• about 15% of patients with neoplastic obstruction develop cholangitis
• the likelihood of infection seems greatest when the duct has acquired a resident bacterial population.

Obstruction causes an increase in ductal pressure. The bacteria proliferate and escape into the systemic circulation via the hepatic sinusoids. The manifestations of sepsis may overshadow those of hepato-biliary disease causing acute suppurative cholangitis.

Without prompt diagnosis and treatment, acute cholangitis can lead rapidly to septicaemia, shock and death:

• mortality of patients with acute cholangitis after 2000 is between 2.7–10 %
  • there is evidence that patients aged 80 years or more have a higher mortality than younger patients
  • poorer prognosis is associated with co-morbid disease, such as cirrhosis, malignancy, liver abscesses, hypoalbuminaemia or coagulopathy

Reference:

1. Lan Cheong Wah D, Christophi C, Muralidharan V. Acute cholangitis: current concepts. ANZ J Surg. 2017 Jul;87(7-8):554-559.