In suspected acute cholangitis due to CBD stone, which interventions are part of management?

In suspected acute cholangitis due to CBD stone, which interventions are part of management?

• A. Broad-spectrum antibiotics alone
• B. Broad-spectrum antibiotics with ERCP and sphincterotomy and stone extraction
• C. Observation only
• D. Cholecystectomy first

Answer: (B)

In suspected acute cholangitis from a CBD stone, the essential approach is to treat the infection while immediately relieving the biliary obstruction. This means starting broad-spectrum antibiotics to cover Gram-negative and anaerobic bacteria, plus urgent biliary decompression via ERCP with sphincterotomy and stone extraction. The antibiotics help control the infection, but without removing the obstruction the infection can persist and worsen. ERCP not only decompresses the biliary tree but also allows removal of the stone, which addresses the root cause and improves drainage. After stabilization, cholecystectomy is not the first step during the acute episode, since the priority is source control of the CBD obstruction; gallbladder removal can be planned later. Observation alone or antibiotics alone don’t provide adequate source control, so they’re not sufficient as the sole strategy.

In suspected acute cholangitis from a CBD stone, the essential approach is to treat the infection while immediately relieving the biliary obstruction. This means starting broad-spectrum antibiotics to cover Gram-negative and anaerobic bacteria, plus urgent biliary decompression via ERCP with sphincterotomy and stone extraction. The antibiotics help control the infection, but without removing the obstruction the infection can persist and worsen. ERCP not only decompresses the biliary tree but also allows removal of the stone, which addresses the root cause and improves drainage. After stabilization, cholecystectomy is not the first step during the acute episode, since the priority is source control of the CBD obstruction; gallbladder removal can be planned later. Observation alone or antibiotics alone don’t provide adequate source control, so they’re not sufficient as the sole strategy.