Cholangitis is an ascending infection of the common bile duct (CBD) secondary to obstruction and increased intraluminal pressure. It was first described in 1877 by Jean-Martin Charcot.


  • MCC: choledocholithiasis
  • Benign or malignant stricture of bile duct or hepatic ducts
    • Pancreatic cancer
    • Ampullary adenoma or cancer
    • Porta hepatitis tumor or metastasis
    • Biliary stent obstruction
    • Primary sclerosing cholangitis
    • Amyloid deposition in biliary system
  • Parasites
  • Mirizzi syndrome
  • Lemmel syndrome
  • AIDS


  • Uncommon
  • Equal distribution between males and females


  • Charcot’s triad: RUQ pain, fever, jaundice (rarely presents with all three)
  • May progress to septic shock and present with Reynold’s pentad
  • Reynold’s pentad: Charcot’s triad, altered mental status, hypotension 


  • US
    • Findings: thickening of the walls of the bile duct, dilatation of biliary ducts (including the CBD), evidence of cholelithiasis and pyogenic material
  • CT
    • Can be performed a adjunct to investigate coexisting pathologies
    • May help with differential diagnoses
    • Poor sensitivity for choledocholithiasis
    • Often needed to aid in diagnosis and in identifying sources of obstruction


  • Emergent, life-threatening condition!
  • IVF 
  • IV antibiotics: directed towards enteric pathogens (such as fluoroquinolones, extended-spectrum penicillins, carbapenems, and aminoglycosides)
  • Biliary drainage
    • Indicated if patient is severely ill with sepsis 
    • ERCP
      • Gold standard, treatment of choice
      • Effective 94 – 98% of the time
    • Percutaneous transhepatic cholangiography (PTC)
    • Endoscopic ultrasound (EUS)
    • Surgical drainage via cholecystectomy

Relevant Information


  • Hepatic abscess
  • Acute cholecystitis
  • Portal vein thrombosis
  • Acute biliary pancreatitis
  • Liver failure
  • Acute renal failure
  • Bacteremia/septicemia
  • Multiple organ failure

Differential Diagnoses

  • Acute cholecystitis
  • Cirrhosis of liver
  • Acute hepatitis
  • Liver abscess
  • Septic shock
  • R sided diverticulitis
  • R sided pyelonephritis