Acute cholangitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 28 Nov 2025

Last updated: 26 Mar 2025

Acute cholangitis is an infection of the biliary tree that requires prompt diagnosis and treatment.

Most patients with acute cholangitis have fever, jaundice, and right upper quadrant pain (Charcot triad).

Cholangitis can quickly become an acute, septic, life-threatening infection that requires rapid evaluation and treatment.

The most common causes are choledocholithiasis and benign or malignant strictures.

Antibiotics alone do not provide sufficient treatment in the majority of patients. Drainage of the biliary tree is the most critical step in management.

If untreated, sepsis with shock, vascular collapse, multiorgan failure, and potentially death can occur.

Definición

Ascending cholangitis is the historical term for the condition currently referred to as acute cholangitis or simply as cholangitis.

Acute cholangitis is an infection of the biliary tree, most commonly caused by obstruction. In its less severe form, there is biliary obstruction with inflammation and bacterial seeding and growth in the biliary tree. It is estimated that 50% to 70% of these patients present with right upper quadrant pain, fever, and jaundice.[1] In the more severe, life-threatening form, known as toxic cholangitis or cholangitis with sepsis, patients have purulent biliary tree contents, as well as evidence of sepsis, hypotension, multiorgan failure, and mental status changes.[1][2]

Anamnesis y examen

Principales factores de diagnóstico

right upper quadrant (RUQ)/upper abdominal pain
RUQ/upper abdominal tenderness
jaundice
fever

Todos los datos

Otros factores de diagnóstico

pale stools
pruritus
hypotension
mental status changes

Todos los datos

Factores de riesgo

older age
cholelithiasis
benign stricture
malignant stricture
postprocedure injury of bile ducts
history of primary sclerosing cholangitis
history of secondary sclerosing cholangitis
HIV infection
use of immune checkpoint inhibitors
immunoglobulin (Ig) G4-related digestive disease

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

CBC
serum BUN
serum creatinine
blood gas analysis
serum LFTs
CRP
serum potassium
serum magnesium
blood cultures
coagulation panel
transabdominal ultrasound

Todos los datos

Pruebas diagnósticas que deben considerarse

endoscopic retrograde cholangiopancreatography (ERCP)
abdominal CT scan with intravenous contrast
magnetic resonance cholangiopancreatography (MRCP)
endoscopic ultrasonography (EUS)
surgical approaches

Todos los datos

Algoritmo de tratamiento

Agudo

acutely ill

En curso

with choledocholithiasis, PSC, or HIV cholangiopathy

Colaboradores

Consejeros especializados

Douglas G. Adler, MD, FACG, AGAF, FASGE

Professor of Medicine

Director, Center for Advanced Therapeutic Endoscopy (CATE)

Porter Adventist Hospital, Centura Health

Denver

Divulgaciones

DGA has provided consulting and speaking services for Abbvie, Boston Scientific Olympus America, and Cook Endoscopy, some of which make products relevant to this topic. He is also an author of references cited in this topic.

Agradecimientos

Dr Douglas G. Adler would like to gratefully acknowledge Dr Andrew S. Fedoravicius, a previous contributor to this topic.

Divulgaciones

ASF declares that he has no competing interests.

Revisores por pares

Christian Macutkiewicz, MD, FHEA, FRCS

Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon

Manchester Royal Infirmary

Manchester

Divulgaciones

CM declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

Divulgaciones

DJH declares that he has no competing interests.

Todd Baron, MD

Professor of Medicine

Division of Gastroenterology & Hepatology

Mayo Clinic Rochester

Rochester

Divulgaciones

TB is an author of a reference cited in this topic.

Dennis Freshwater, MB, BS, MD, FRCP

Consultant Hepatologist

The Liver and Hepatobiliary Unit

Queen Elizabeth Medical Care Unit

University Hospitals Birmingham NHS Foundation Trust

Birmingham

Divulgaciones

DF declares that he has no competing interests.

Bertus Eksteen, MRCP, PhD, MRC

Clinical Scientist

University of Birmingham

Honorary Consultant

Liver Transplant Unit

University Hospitals Birmingham NHS Foundation Trust

Birmingham

Divulgaciones

BE declares that he has no competing interests.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30.Texto completo Resumen

Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):31-40.Texto completo Resumen

Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16.Texto completo Resumen

Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):96-100.Texto completo Resumen

Mukai S, Itoi T, Baron TH, et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017 Oct;24(10):537-49.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Differentials
- Acute cholecystitis
- Peptic ulcer disease
- Acute pancreatitis
Más Diferenciales
Guidelines
- ACG clinical guideline: diagnosis and management of biliary strictures
- ASGE guideline on the management of cholangitis
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Videos
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Peripheral intravascular catheter: animated demonstration
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Patient information
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Acute cholangitis

Summary

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

acutely ill

with choledocholithiasis, PSC, or HIV cholangiopathy

Colaboradores

Consejeros especializados

Douglas G. Adler, MD, FACG, AGAF, FASGE

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Christian Macutkiewicz, MD, FHEA, FRCS

Divulgaciones

David J. Hackam, MD, PhD

Divulgaciones

Todd Baron, MD

Divulgaciones

Dennis Freshwater, MB, BS, MD, FRCP

Divulgaciones

Bertus Eksteen, MRCP, PhD, MRC

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Differentials

Guidelines

Videos

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice