Acute (ascending) cholangitis

Cholangitis is an infection of an obstructed biliary system, most often resulting from common bile duct stones and often involving enteric bacteria. Patients present with fever, abdominal discomfort, and elevated bilirubin and alkaline phosphatase levels. Ultrasonography is the primary imaging modality, but standard computed tomography and helical CT cholangiography, magnetic resonance cholangiography, endosonography, and invasive cholangiographic methods, such as endoscopic retrograde cholangiopancreatography, may provide important additional information on biliary pathology. Initial treatment uses antimicrobial therapy and, when necessary, biliary decompression, which is preferentially performed by endoscopy.