Faculty mentor/PI email address
jim010@aol.com
Is your research Teaching and Learning based?
1
Keywords
ascending cholangitis, sepsis, choledocholithiasis, encephalopathy
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Acute cholangitis is a potentially life-threatening biliary infection usually precipitated by ductal obstruction. In adults ≥80 years, classic right upper quadrant pain and jaundice may be absent and delirium may predominate, increasing the risk of diagnostic delay.¹
An 82-year-old woman presented with generalized weakness and altered mental status. She was febrile (101.9 °F [38.8 °C]) and tachycardic (113 beats/min) without hypotension. Laboratory testing demonstrated leukocytosis and marked cholestatic liver injury (total bilirubin 2.8 mg/dL, alkaline phosphatase 660 U/L) with hyperbilirubinemia and acute encephalopathy consistent with sepsis-associated organ dysfunction. Computed tomography and ultrasound suggested biliary obstruction and cholelithiasis; magnetic resonance cholangiopancreatography confirmed choledocholithiasis. She received intravenous fluids and broad-spectrum antibiotics, then underwent endoscopic retrograde cholangiopancreatography with sphincterotomy, balloon extraction of common bile duct stones, purulent drainage consistent with ascending cholangitis, and plastic biliary stent placement. She later underwent laparoscopic cholecystectomy during the same admission.
This case highlights atypical cholangitis presentation in an older adult and illustrates successful management with early antibiotics and timely endoscopic biliary drainage followed by definitive gallbladder surgery.
Disciplines
Digestive System Diseases | Medicine and Health Sciences
Included in
Case Report: Ascending Cholangitis Presenting as Sepsis with Encephalopathy in an Older Adult with Choledocholithiasis
Acute cholangitis is a potentially life-threatening biliary infection usually precipitated by ductal obstruction. In adults ≥80 years, classic right upper quadrant pain and jaundice may be absent and delirium may predominate, increasing the risk of diagnostic delay.¹
An 82-year-old woman presented with generalized weakness and altered mental status. She was febrile (101.9 °F [38.8 °C]) and tachycardic (113 beats/min) without hypotension. Laboratory testing demonstrated leukocytosis and marked cholestatic liver injury (total bilirubin 2.8 mg/dL, alkaline phosphatase 660 U/L) with hyperbilirubinemia and acute encephalopathy consistent with sepsis-associated organ dysfunction. Computed tomography and ultrasound suggested biliary obstruction and cholelithiasis; magnetic resonance cholangiopancreatography confirmed choledocholithiasis. She received intravenous fluids and broad-spectrum antibiotics, then underwent endoscopic retrograde cholangiopancreatography with sphincterotomy, balloon extraction of common bile duct stones, purulent drainage consistent with ascending cholangitis, and plastic biliary stent placement. She later underwent laparoscopic cholecystectomy during the same admission.
This case highlights atypical cholangitis presentation in an older adult and illustrates successful management with early antibiotics and timely endoscopic biliary drainage followed by definitive gallbladder surgery.