First described by Jean Marie Charcot in 1877, acute (ascending) cholangitis occurs in an infected and usually obstructed biliary system, typically at the level of the common bile duct. This illness is characterized by fever, abdominal pain, and jaundice and is an important cause of the “acute abdomen.” If the biliary obstruction is not relieved, persistently elevated intraductal pressures can cause reflux of biliary contents and bacteremia, ultimately leading to sepsis.Bile is normally sterile because of the constant flow into the duodenum, flushing the biliary system, and the antibacterial properties of immunoglobulin A and bile salts in the bile itself. The sphincter of Oddi also helps to prevent intestinal contents from refluxing onto the common bile duct. Obstruction of the common bile duct causes a rise in pressure that leads to edema and necrosis of the walls of the biliary tree. Obstructions are primarily due to gallstones in the majority of cases, and these may arise from the gallbladder or spontaneously form in the common bile duct after cholecystectomy. Other reasons for biliary obstruction include malignancy, benign strictures, congenital abnormalities, cysts, parasites (Ascaris, Clonorchis, or Echinococcus species), pancreatitis, or extrinsic compression. In the presence of any of these causes of obstruction, bacteria may reach the biliary tree by either reflux from the duodenum or translocation from the portal circulation. *106/348/5*
