Abstract
Acute cholangitis is a bacterial infection superimposed on an obstruction of biliary
tree from a gall stone, neoplasm or stricture. The biliary obstruction is most commonly
caused by choledocholithiasis benign or malignant stricture of the bile duct or hepatic
ducts, pancreatic cancer, ampullary adenoma or cancer, porta hepatis tumour or metastasis,
biliary stent obstruction (due to microbial biofilm formation, biliary sludge deposition
and duodenal reflux of food content), primary sclerosing cholangitis and amyloid deposition
in the biliary system. Classically, patients present with high fever persisting for
more than 24 hours, abdominal pain and jaundice (Charcot's triad). The right upper
quadrant abdominal (RUQ) pain is generally mild. When the cholangitis becomes more
severe, patients become hypotensive and confused (Reynold's pentad). Charcot's triad
has low sensitivity (26.4%) and high specificity (95.9%). Although the presence of
Charcot's triad is suggestive of acute cholangitis, it is not diagnostic. Charcot's
triad is present in 26.4 to 72% of patients with acute cholangitis. TG07 diagnostic
criteria for acute cholangitis also do not have enough sensitivity and specificity
and its severity criteria are also not suitable for clinical use. Antibiotics, intravenous
fluid, Vitamin K supplementation and biliary drainage are the options available in
conventional mode of treatment for acute cholangitis. Presented here is one case report
of acute cholangitis in a patient of adenocarcinoma of gall bladder with metastasis.
The case was treated using classical method of homoeopathy with complete improvement
in clinical and laboratory parameters of acute cholangitis.
Keywords
cholangitis - homoeopathy - adenocarcinoma - gall bladder - metastasis
