Cholangitis is inflammation and infection of the bile ducts, usually caused by an obstruction that prevents normal bile drainage. Common causes include gallstones in the common bile duct, bile duct strictures, tumors, or complications related to biliary procedures or stents. Acute cholangitis can become a serious systemic infection and requires prompt medical treatment.
Timely treatment is important because infection within an obstructed biliary system can progress to sepsis, organ dysfunction, and other life-threatening complications. Treatment generally involves antibiotics, supportive care, and restoration of bile drainage when obstruction is present.
Causes
Risk Factors
Advances in cholangitis management include improved biliary imaging, endoscopic drainage, and minimally invasive techniques to relieve bile duct obstruction. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) help identify the cause and location of obstruction, while endoscopic retrograde cholangiopancreatography (ERCP) can remove stones, place stents, and drain infected bile. For complex obstructions, clinicians may consider cholangioscopy-guided stone removal and specialised biliary drainage techniques. Treatment also involves prompt antibiotics and supportive care, with urgent biliary drainage when indicated. In Malaysia, access to advanced endoscopic and interventional procedures varies by hospital. Acute cholangitis can be life-threatening and requires urgent medical assessment.
Biliary drainage: Endoscopic drainage, usually through ERCP, may be required to relieve obstruction and allow infected bile to drain.
Stone removal : If gallstones are responsible, stones may be removed during ERCP when appropriate.
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Biliary stenting: Place a temporary or longer-term stent to maintain bile duct drainage in selected patients.
Alternative drainage: Consider percutaneous transhepatic biliary drainage or EUS-guided biliary drainage when ERCP is unsuccessful or not feasible.









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