Surgical Jaundice and Cholangitis

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. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.