Treatment of Choledocholithiasis in Moderate Acute Cholangitis with Leukocytosis, High Fever, or Other Severity Markers

This protocol covers choledocholithiasis presenting alongside moderate acute cholangitis — a clinically significant escalation defined by the concurrent presence of at least two recognised severity indicators.

Clinical scenario

Moderate acute cholangitis is identified when at least two of the following are present:

Leukocytosis (>12,000) or leukopenia (<4,000)
Fever above 39°C
Age over 75 years
Total bilirubin >5 mg/dL
Hypoalbuminemia (<0.7 × upper limit of normal reference range)

In this setting, adequate control of the infection source is the clinical priority. Management involves an endoscopic approach targeting biliary drainage — the full protocol defines the specific intervention, the procedural window, and the conditions that govern it.

The complete, structured regimen with all procedural and timing details is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Moderate acute cholangitis, diagnosed by at least two of the following indicators:
Leukocytosis, >12000 or leukopenia, <4000
Fever with a temperature above 39°C
Age >75 years old
Total bilirubin >5 mg/dL
Hypoalbuminemia, <0.7 times the maximum normal reference range.
More severe cholangitis requires more immediate ERCP to perform biliary drainage, so that the infection source can be controlled adequately.
Moderate acute cholangitis: within 48–72 hours

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