Treatment of Choledocholithiasis in Severe Acute Cholangitis

Clinical Scenario

This protocol addresses choledocholithiasis presenting alongside severe acute cholangitis — a critical presentation defined by any of the following indicators:

Hypotension requiring dopamine >5 mcg/kg/min or norepinephrine
Altered consciousness
PaO₂/FiO₂ ratio <300
Oliguria with creatinine >2 mg/dL
INR >1.5
Thrombocytopenia below 100,000

Approach: Severe acute cholangitis in the setting of choledocholithiasis calls for urgent endoscopic biliary drainage — with timing being a critical determinant of outcome. The complete regimen and procedural criteria are in the full protocol.

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References

Severe acute cholangitis, diagnosed by these indicators:
Hypotension that requires dopamine doses of >5 mcg/kg/min or norepinephrine
Altered consciousness
PaO₂/FiO₂ ratio <300
Oliguria, creatinine >2 mg/dL
INR >1.5
Thrombocytopenia, below 100000
More severe cholangitis requires more immediate ERCP to perform biliary drainage, so that the infection source can be controlled adequately.
Severe acute cholangitis: as soon as possible and before 12 hours

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