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Surgical Jaundice and Cholangitis

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Textbook of Emergency General Surgery

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Abstract

Jaundice may result from various illnesses, among which obstruction of the biliary tree is the main surgical focus. Cholangitis is generally associated with infection in the presence of biliary obstruction. Cholangitis occurs when partial or complete obstruction of the bile duct exists, resulting in increased intraluminal pressure and infected bile proximal to the obstruction. Patients with cholangitis may present with right upper quadrant abdominal pain, fever, and/or jaundice (Charcot’s triad); patients with “toxic” cholangitis—Charcot’s triad plus shock and mental confusion (Reynold’s pentad). Diagnosis is based on physical examination and laboratory testing, and with help of radiologic imaging the cause can be revealed. Previous option for the relief of obstructive jaundice was operative intervention. Today, the surgeon must determine the safest and most effective therapy for each patient and prepare them for surgery or nonoperative therapeutic intervention (stenting, balloon dilation, sphincterotomy). All patients being treated for cholangitis should be resuscitated, electrolyte imbalances corrected, IV antibiotics administered, and closely monitored. After resuscitation, imaging of the biliary tree is needed in order to find the location and cause of the obstruction. Further management is conducted accordingly. However, it cannot be stressed enough that the definitive treatment for cholangitis is biliary decompression.

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Further Reading

  • Calvino AS, Espat NJ. Cholangitis. In: Jarnagin WR, editor. BLUMGART’S surgery of the liver, biliary tract and pancreas. 6th ed. Philadelphia: Elsevier; 2017. p. 714–24.

    Chapter  Google Scholar 

  • Miura F, Okamoto K, Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM, et al. Tokyo guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):3–16. https://doi.org/10.1002/jhbp.518.

    Article  PubMed  Google Scholar 

  • Pitt HA. Bile secretion and pathophysiology of biliary tract obstruction. In: Jarnagin WR, editor. BLUMGART’S surgery of the liver, biliary tract, and pancreas. 6th ed. Philadelphia: Elsevier; 2017. p. 123–32.

    Chapter  Google Scholar 

  • Takada T, Strasberg SM, Asbun HJ, Pitt HA, et al. Tokyo guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):31–40. https://doi.org/10.1002/jhbp.509.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Aleksandar R. Karamarkovic, Jovan T. Juloski & Vladica V. Cuk

  2. Surgical Clinic “Nikola Spasic”, Zvezdara University Medical Center, Belgrade, Serbia

    Aleksandar R. Karamarkovic, Jovan T. Juloski & Vladica V. Cuk

Authors
  1. Aleksandar R. Karamarkovic
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  2. Jovan T. Juloski
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  3. Vladica V. Cuk
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Correspondence to Aleksandar R. Karamarkovic .

Editor information

Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Karamarkovic, A.R., Juloski, J.T., Cuk, V.V. (2023). Surgical Jaundice and Cholangitis. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_59

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_59

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