Symptoms and Treatment of Acute Cholangitis

An infection in the bile ducts can be serious but most people recover

The gallbladder and bile ducts in situ
Encyclopaedia Britannica/UIG / Getty Images

Cholangitis is an infection of the bile ducts. Acute cholangitis may cause symptoms of fever, jaundice, and abdominal pain. The condition is sometimes called ascending cholangitis.

Acute cholangitis is a serious illness that requires treatment. It is vital that people with this type of infection get diagnosed and treated promptly in order to avoid more serious complications. The prognosis for cholangitis has improved in recent years and most people recover with treatment.

Bile Duct Blockages

Bile is a substance that helps break down the fat in food so that it can be digested. Bile is created in the liver and travels through channels called bile ducts to the gallbladder, where it is stored until it is needed. After a meal, especially one that includes fats, bile is released through the common bile duct and into the first part of the small intestine (the duodenum). 

Sometimes the bile ducts can get blocked or, rarely, become too narrow. This can happen when gallstones form or when there is another reason that the ducts are narrowed, such as the growth of a tumor near the duct or a bile duct stricture. Gallstones are more common in women, people with inflammatory bowel disease (IBD, particularly Crohn’s disease), sclerosing cholangitis, and HIV/AIDS. Tumors or strictures as a cause for the bile ducts being narrowed are less common.

When a bile duct is blocked from a gallstone or another reason, there’s the potential for it to become infected with bacteria. An infection can also happen after surgery where a stent is placed in the bile duct. This type of bacterial infection is called cholangitis.

Risk Factors

The risk of developing cholangitis is going to depend on a number of factors but there are a few conditions that can make this infection more likely. People who are at a greater risk of developing an infection in the bile duct includes anyone who has:

  • A history of gallstones
  • A diagnosis of sclerosing cholangitis
  • Recently traveled to areas where parasitic or bacterial infections can occur
  • A recent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement (in one study, the risk was 13.2 percent)

Signs and Symptoms

The signs and symptoms of acute cholangitis are often similar to that of gallstones and can include:

  • Back pain
  • Chills
  • Clay-colored stools
  • Darkened urine
  • Fever
  • Jaundice (yellowing of the skin and eyes)
  • Nausea
  • Pain below the shoulder blade
  • Right upper quadrant or middle abdominal pain that is sharp, crampy or dull
  • Vomiting


Making a diagnosis of cholangitis as quickly as possible in order to start treatment is important. One or more of several different tests that looks at the gallbladder and bile ducts might be used.

Blood tests

While blood tests won’t be used alone to diagnose an infection in the bile ducts, they are used to help get an overall picture of what might be causing the symptoms. The blood tests that might be done include:

Abdominal ultrasound

An ultrasound is a test that uses sound waves in order to see the structures inside the body. It might be done on the abdomen when a gallstone or a bile duct obstruction is suspected.


During this test, a tube is passed through the mouth and down through the digestive tract to reach the bile ducts. This may also be used in some cases to remove gallstones or treat another form of blockage or obstruction of the bile ducts. During this test some bile might be removed in order to test it for bacteria. The bile will be cultured in a lab to find out what bacteria is causing the infection.

Magnetic resonance cholangiopancreatography (MRCP)

This test is an imaging test that’s not invasive and is used to visualize the pancreas, gallbladder, and bile ducts. Any blockages in the bile ducts might be seen on the images taken.

Percutaneous transhepatic cholangiogram (PTCA)

The PTCA is a type of X-ray that’s used to see the bile ducts. While the patient is sedated, a needle is inserted through the abdomen and into the liver to administer a contrast medium to the area. Then a series of X-rays are taken to visualize the ducts with the contrast medium flowing through them.


Once the diagnosis is made, treatment should start promptly. Because cholangitis is caused by an infection, treatment will include antibiotics to kill the bacteria. Secondarily, the root cause needs to be treated. In the case of gallstones, the stones might be treated by removing them with an ERCP when the stones are in the common bile duct. In many cases, gallbladder removal surgery might be done. 

For strictures in the bile duct, a procedure might be done to place a stent and to keep the duct open. In the case where there’s a narrowing of the bile ducts because of a tumor (which is not common), that could require surgery or other forms of treatment.


Sepsis is one potential complication of cholangitis, and it is a life-threatening condition. Sepsis occurs when an infection isn’t treated and causes organ failure, tissue damage, and possibly death. Sepsis is treated with antibiotics and sometimes other measures are needed to help remove infected tissue. Sepsis can be insidious and life-threatening, which is why it’s important to alert medical professionals right away if it’s suspected that an infection has turned into this condition.


In some cases, preventing cholangitis might not be possible. However, as most cases are caused by gallstones blocking the bile ducts, preventing gallstones may help. Preventing gallstones can include eating a healthy diet with appropriate amounts of soluble and insoluble fiber and getting regular exercise. Stopping smoking may also help prevent the development of more serious forms of cholangitis. For cholangitis associated with ERCP and stent placement, antibiotics might be given at the time of the procedure or after to prevent an infection.

A Word from Verywell

Acute cholangitis is a serious condition because it is an infection that can make a person quite ill and lead to complications. Getting diagnosed promptly and receiving treatment is important, therefore symptoms of abdominal pain, jaundice, and fever are a cause to see a physician right away. When the diagnosis is prompt and treatment with antibiotics is started, the good news is that most people recover from cholangitis.  

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ahmed M. Acute cholangitis - an update. World J Gastrointest Pathophysiol. 2018;9(1):1-7.  doi:10.4291/wjgp.v9.i1.1

  2. Bile Duct Obstruction. US National Library of Medicine. April 2018.

  3. Cholangitis. US National Library of Medicine. January 2020.

  4. Galeazzi M, Mazzola P, Valcarcel B, et al. Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians' point of view. BMC Gastroenterol. 2018;18(1):38.  doi:10.1186/s12876-018-0764-4

  5. Willis L. Professional Guide to Diseases (Professional Guide Series) Tenth Edition. LWW. 2012.

  6. Diagnosis of Primary Sclerosing Cholangitis. National Institute of Diabetes and Digestive and Kidney Diseases. January 2018.

  7. Percutaneous transhepatic cholangiogram. US National Library of Medicine. December 2018.

  8. Costamagna G, Boškoski I. Current treatment of benign biliary strictures. Ann Gastroenterol. 2013;26(1):37-40.

  9. What is Sepsis?. Centers for Disease Control and Prevention. August 2019.

  10. Njeze GE. Gallstones. Niger J Surg. 2013;19(2):49-55.  doi:10.4103/1117-6806.119236

Additional Reading
  • Tierney J, Bhutiani N, Stamp B, et al. Predictive risk factors associated with cholangitis following ERCPSurg Endosc. 2018:32;799. doi: 10.1007/s00464-017-5746-z

  • Yeom DH, Oh HJ, Son YW, Kim TH. "What are the risk factors for acute suppurative cholangitis caused by common bile duct stones?" Gut Liver. 2010;4:363. DOI: 10.5009/gnl.2010.4.3.363

  • Afdhal, NH. "Acute cholangitis." UpToDate. 18 Mar 2016. 
  • Centers for Disease Control and Prevention. "Sepsis." 23 Jan 2018. 

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.