Pang and Chun identified factors associated with the need for emergency biliary decompression in a patient with acute cholangitis. The authors are from Kwong Wah Hospital in Hong Kong.


Patient selection: acute cholangitis


Reason for urgent decompression: peritonitis


Key predictors for urgent biliary drainage:

(1) age > 75 years of age

(2) long-term smoking


Other predictors:

(3) hyperglycemia (> 8.0 mmol/L)

(4) prolonged prothrombin time

(5) dilated common bile duct on ultrasonography


A patient without any of the risk factors can be managed conservatively with antibiotics.


The presence of one or both of the key predictors indicates the need for urgent biliary drainage.


In the implementation the following will be used as additional reasons for biliary decompression:

(1) presence of signs of peritonitis (see above).

(2) presence of 2 or more of the other indicators


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