Cholangitis

Cholangitis is most often caused by bacteria. This can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver. This is called ascending cholangitis.

Risk factors include a previous history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and rarely, travel to countries where you might catch a worm or parasite infection.

The following symptoms may occur:

• Pain on the upper right side or upper middle part of the abdomen. It may also be felt in the back or below the right shoulder blade. The pain may come and go and feel sharp, cramp-like, or dull.
• Fever and chills.
• Dark urine and clay-colored or pale stools.
• Nausea and vomiting.
• Yellowing of the skin (jaundice), which may come and go.

You may have the following tests to look for blockages:

• Abdominal ultrasound
• Abdominal CT scan
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

You may also have the following blood tests:

• Bilirubin level
• Liver enzyme levels
• Liver function tests
• White blood count (WBC)

Quick diagnosis and treatment are very important.

Antibiotics to cure the infection are the first treatment done in most cases. ERCP or a surgical procedure is done when the person is stable. ERCP will drain the infection, which is usually needed along with antibiotics.

People who are very ill or are quickly getting worse may need surgery right away.

The outcome is very often good with treatment, but poor without it.

Complications may include:

• Sepsis
• Heart failure
• Multiple organ failure
• Pneumonia
• Death

Contact your health care provider if you have symptoms of cholangitis.

Treatment of gallstones, tumors, and infestations of parasites may reduce the risk for some people. A metal or plastic stent that is placed in the bile system may be needed to prevent the infection from returning.

Acute cholangitis; Ascending cholangitis; Suppurative cholangitis

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 141.

Sifri CD, Madoff LC. Infections of the liver and biliary system (liver abscess, cholangitis, cholecystitis). In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 77.

Wang DQH, Afdahl NH, Wang D. Gallstone disease. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 67.

Updated by: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.