Abstract
We diagnose, judge the severity of, and treat acute cholangitis according to the “‘Japanese Guidelines for the management of acute cholangitis and cholecystitis’”. The indication of emergency drainage of the common bile duct (CBD) is determined by the response to initial conservative treatment for moderate cases. Two hundred two cases of acute cholangitis (AC) due to CBD stones were analyzed retrospectively. The severity of AC patient cases at the time of admission was as follows：28.2% were mild, 62.4% were moderate, and 9.4％ were severe. Emergency drainage in the moderate cases showed a significant difference between the cases with 2 or less criteria of moderate cholangitis and those with 3 or more (28.9% and 58.3%, respectively; p<0.05.) All of the severe cases underwent emergency drainage except the cases that were diagnosed as severe using only the criterion of bacteremia. We performed lithotomy as the initial therapy for half of the cases that underwent emergency drainage. The survival rate was 98.5％. Our recommendation is that emergency drainage is necessary for severe cases of AC except for 1) those with only bacteremia and 2）those with 3 or more criteria of moderate cholangitis.
