Cholangitis refers to infection and inflammation of the bile ducts because of obstruction and introduction of bacteria or other pathogens from the GI tract.

The treatment for biliary cholangitis requires intervention, surgical or advanced gastroenterology, and involves

• Hydration with IV fluids,
• Broad coverage with IV antibiotics administration and
• Drainage procedure (ERCP, papillotomy, Stent placement, Cholecystectomy with common duct exploration, and T-tube placement)

These steps are almost all taking place concurrently and urgently. This is not something a patient waits and sees how it goes- it only goes one direction, from bad to worse. This is not to sound alarmist; a correct diagnosis is critical.

Risk factors for cholangitis may include gallstones that travel down the bile duct and cause jaundice, pancreatitis if passed, immunosuppression, malnutrition, and diabetes, to name a few.

If a patient has gallstones in the bile duct less than 2 years after cholecystectomy, it is a Retained Stone(s), meaning there was a small stone that was not in the gallbladder and was not seen on US, intraoperative cholangiogram, or ERCP (if performed before surgery).

If a patient has gallstones in the bile duct more than 2 years after cholecystectomy, they are Primary Biliary Stone(s), meaning the stone(s) formed in the biliary tree after cholecystectomy.