The main function of the gallbladder is to collect the bile produced in the liver. When food is ingested, the bile is released through the bile duct into the duodenum. There the bile emulsifies the food pulp.
Bacteria from the duodenum can enter the bile ducts due to obstructions to the outflow and lead to inflammation. This is known as acute cholangitis. It causes fever and can be life-threatening. If left untreated, the bacteria can spread to the liver.
The most common pathogens are E. coli and enterococci, followed by
- Klebsiella,
- Enterobacter and
- Clostridium perfringens.
The most common causes of blocked bile ducts or impaired drainage are
- Gallstones,
- stenoses,
- tumors or
- parasite infestation.

Gallstones in the bile ducts are often the cause of cholangitis © Henrie | AdobeStock
In exceptional cases, cholangitis can become chronic without an infectious trigger. This is known as primary sclerosing cholangitis. This leads to chronic bile stasis and ultimately to scarred destruction of the liver.
The cause of this form of the disease is unknown. It is thought to be caused by an autoimmune disease.
The main symptoms of acute cholangitis are
- High fever and chills lasting several days with
- constant right-sided upper abdominal pain.
- After a few days, the skin turns yellow.
Primary sclerosing cholangitis is characterized by a gradual, often asymptomatic progression over years.
- Fatigue,
- feeling of pressure,
- pain in the right upper abdomen and
- slight fever
are the main signs.
Laboratory analysis methods
A blood test can be used to detect elevated bile levels and signs of inflammation, such as
- Increase in the number of white blood cells,
- acceleration of the erythrocyte sedimentation rate and
- increase in the concentration of CRP (C-reactive protein)
can be determined.
Ultrasound examinations
Gallstones are often the cause of inflammation of the bile ducts. They can be detected by an ultrasound examination.
During the painless and uncomplicated examination, the doctor feels
- the gallbladder,
- bile ducts and
- liver and
- liver and usually also the pancreas
using a transducer.
ERCP
Endoscopic retrograde cholangiopancreatography (ERCP) is mainly used in cases of suspected gallstones in the bile ducts. The procedure allows precise visualization of the bile ducts, gallbladder and pancreatic duct.
During the procedure, the doctor can also directly remove stones or widen the opening of the bile duct.
Acute inflammation of the bile ducts is treated with
- high doses of antibiotics,
- additional administration of painkillers and
- antipyretics
therapy.
To eliminate the cause, the gallstones must be removed. If they are smaller than five millimetres and free of calcium, dissolving medication containing artificial bile acid is prescribed.
Stone fragmentation using shock waves (ultrasound wave treatment) may also be considered. The fragments of the gallstones are then dissolved with medication.
In the case of recurrent inflammation of the bile ducts caused by larger gallstones, surgical removal of the gallbladder is an option (cholecystectomy).
The removal of the gallbladder is a minimally invasive procedure that only requires four small incisions to insert the instruments. Gas is first used to inflate the surgical area so that the individual structures can be separated from each other.
After the operation, small sutured incisions remain, which are barely visible after a while.
If the removal of the gallstone does not resolve the bile duct inflammation, a stent is inserted. This stent is a small tube that keeps the bile duct open and thus regulates the outflow of bile secretions.
Primary sclerosing cholangitis can only be treated symptomatically.