Diagnosis and management approach of acute cholangitis with sepsis complications in a peripheral hospital: a case report

Abstract

Acute cholangitis is a systemic, life-threatening condition that develops as a result of obstruction and infection of the bile ducts. The two main processes leading to acute cholangitis include obstruction of the biliary tract and the growth of bacteria in the bile. A case of acute cholangitis has been reported at Rote Ndao public hospital, Rote Ndao district, East Nusa Tenggara, in a 57-year-old woman, with the main complaint of right upper abdominal pain, jaundice, and fever. The diagnostic approach is based on anamnesis, physical examination, and supporting examinations. Based on the Tokyo guideline 2018 (TG18) the patient met a suspected diagnosis, with A criteria that was evidence of systemic inflammation in the form of fever (body temperature 38.7^o C), evidence of an inflammatory response with increasing leukocyte count (26,200/cm³), and for the B criteria that was evidence of cholestasis in the form of jaundice, increasing of total bilirubin (19.8 mg/dL), abnormal liver function tests (SGOT 135 IU/L, SGPT 74 IU/L), while C criteria cannot be performed due to limited hospital imaging facilities. Limitations of investigations should not limit the diagnosis and initial management so it can give the good prognosis. Even though there were complications of sepsis, the patient did not experience signs of shock which could lead to mortality.