Approach to the patient who has suspected acute bacterial cholangitis.

Table 4 gives summary recommendations concerning the major decisions that are related to the diagnosis and management of suspected acute bacterial cholangitis. All of these decisions have to be made within the context of disease severity, degree of diagnostic uncertainty, and associated comorbidity. Although these recommendations are based on evidence, there are few randomized controlled trials. Antibiotics that cover gram negatives and anaerobes, along with fluid and electrolyte correction, frequently stabilize the patient. Imaging studies frequently confirm the diagnosis and identify the location and etiology of the obstruction. With or without a definitive diagnosis, ERCP or PTC can be done emergently to establish drainage to control sepsis. Although endoscopic and percutaneous drainage techniques have lower morbidity and mortality than does emergent surgical decompression, optimal management of this potentially life-threatening condition requires close cooperation between the gastroenterologist, radiologist, and surgeon.