Answers
What is cholangitis (bile duct infection)?
Short answer
Cholangitis is an infection of the bile duct, almost always because the duct is blocked by a stone, a narrowing, a growth or a blocked stent. It causes fever with chills, jaundice and pain in the upper right belly. It is an emergency: it needs antibiotics and urgent drainage of the bile duct, usually by ERCP.
Symptoms
- Fever with shivering
- Yellow eyes and skin, dark urine
- Pain in the upper right belly
- In severe cases: confusion, low blood pressure and drowsiness
Common causes
- Stones that have slipped from the gallbladder into the bile duct
- A narrowing (stricture) of the bile duct
- Cancer of the pancreas or bile duct
- A bile duct stent that has become blocked, which is why stent change dates should never be missed
Treatment
- Antibiotics through a drip and fluids
- Urgent drainage of the bile duct by ERCP, removing the stone or placing a stent, usually within 24 to 48 hours and sooner if the person is very unwell
- If ERCP is not possible, drainage through EUS or through the skin by a radiologist
- Later, removal of the gallbladder if stones were the cause
When to go to hospital
Fever with chills and yellow eyes, especially in someone with gallstones or a bile duct stent, needs the emergency department the same day. Call 112 if there is confusion or fainting.
Diet after ERCP and recovery
Eat more
- After ERCP: start with sips of water, then light food such as khichdi, dal-rice and curd, as advised
- Small, low-fat meals until the gallbladder is removed, if stones were the cause
- Plenty of fluids during recovery
Cut down
- Heavy, fried or very fatty meals in the first few weeks
- Alcohol
- Eating if there is severe belly pain or vomiting after ERCP; contact your doctor
Good to know
- Keep stent change dates. A blocked stent is a common cause of repeat cholangitis.
- Fever with chills after a stent needs the same-day attention.
Common questions
Is ERCP painful?
It is done under sedation or anaesthesia, so most people do not remember it. Some have a sore throat or bloating for a day.
How long can a bile duct stent stay?
Plastic stents are usually changed or removed within about three months. Metal stents stay longer. Your doctor will give you a date.
Can cholangitis come back?
Yes, if the cause remains, such as gallstones or a narrowing. Removing the gallbladder and treating the narrowing prevent most repeat episodes.