Acute Cholangitis in Elderly Patients Exploring Diagnostic Clues and Clinical Signs

Abstract

AIM: Patients with acute cholangitis (AC) have poor prognoses when treatment is delayed. Diagnostic clues from clinical characteristics are evaluated with case study.

METHODS: We retrospectively investigated the case records of AC patients >65 years of age between April 2008 and June 2011. Our institutional ethical committee determined that this study was not a clinical trial as diagnostic investigations were based on daily clinical practices.

RESULTS: Seventeen patients (7 men and 10 women) were enrolled in this study. All patients were treated endoscopically and common bile duct (CBD) stones were successfully removed. Four patients (23.5%) presented with Charcot’s triad. Ten patients (58.8%) presented with fever and 9 (52.9%) patients presented with abdominal pain. One patient presented with nausea without fever or jaundice. Nine and 10 patients had elevated white blood cell counts and elevated C-reactive protein levels, respectively. Liver dysfunction was observed in most patients. Six patients showed normal CBD diameter on ultrasonography. CBD stones were discovered in 6 patients, 2 of which had normal-sized CBDs.

CONCLUSION: Fever and elevated alkaline phosphatase level are clues for a diagnosis of AC. Ultrasonography should be performed focusing on CBD stones even if CBD diameter is not dilated.