Acute Cholangitis: Etiological Profile and Management

Abstract

Acute cholangitis is defined by an infection of the bile ducts due to an obstacle preventing bile flow. It is a diagnostic and therapeutic emergency. Aim of the Study: Report epidemiological, etiological, therapeutic and evolutionary cholangitis. Materials: This is a descriptive prospective study, spanning a period from September 2020 to April 2023. Patients with acute cholangitis were included. Results: We collected 102 cases. The average age was 63 years old with a Sex ratio M/W: 1.37. 18 patients (17.6%) had a history of cholecystectomy. Abdominal ultrasound was sufficient to visualize the obstruction in 32 (32%) patients. The lithiasic origin was revealed in 54 (53%) cases, pancreatic head tumor in 16 (15.7%), cholangiocarcinoma in 17 (16.6%), ruptured hydatid cyst in the biliary tract in 7 (7%). 100 (98%) patients benefited from endoscopic treatment and 2 (2%) benefited from surgical treatment. Endoscopic biliary sphincterotomy was performed in 84 (84%) patients and sphincteroclasia in 9 (9%) patients. Extraction of the stones or hydatid membranes by balloon was performed in 55 (55%) cases. Mechanical lithotricy was necessary in 1 (1%) case. A biliary prosthesis was placed in 52 (52%) patients (Picture 3). The single-stage success rate was obtained in 91 (91%) cases, 8 patients (8%) required a second stage. The early complication rate after endoscopic managment was 10% (n=10) with a death rate of 5% (n=5). Conclusion: Acute cholangitis remains a severe condition requiring urgent treatment. The prognosis has clearly improved after the advent of interventional endoscopy giving satisfactory results. Our study had shown with a technical success rate of 92.7% and a general success rate of 95%.