ACUTE CHOLANGITIS AND PANCREATITIS SECONDARY TO COMMON DUCT STONES - MANAGEMENT UPDATE

Gallstones are found within the main bile duct (MBD) of 7% to 20% of p atients undergoing cholecystectomy. MBD stones are the commonest cause of acute cholangitis and acute pancreatitis. Acute cholangitis is the result of infection superimposed on an obstructed biliary system and carries a high mortality rate if left untreated. The mainstay of treat ment is a regimen of broad-spectrum intravenous antibiotics followed b y prompt decompression of the obstructed biliary tree. Decompression i s best accomplished by the endoscopic route, although transhepatic app roaches may also be employed. Gallstone pancreatitis may be associated with cholangitis but is also common as a separate entity. Initial tre atment is supportive, although new agents designed to suppress the sys temic inflammatory response are under development and have proved bene ficial in clinical trials. Severe cases should be treated with systemi c antibiotics and early removal of the obstructing stones by endoscopi c retrograde cholangiopancreatography and endoscopic sphincterotomy. P rophylactic cholecystectomy is recommended to prevent further episodes of gallstone pancreatitis.