| Acute cholangitis (AC) is a bacterial infection superimposed on biliary obstruction most commonly from choledocholithiasis, but it may be associated with malignant tumors. Despite different clinical manifestation from AC as a result of choledocholithiasis, AC secondary to malignant biliary obstruction has been fully discussed in the clinical guidelines. In the treatment of AC secondary to malignant biliary obstruction, the patient's condition, including performance status, tumor extension or staging, and prognosis must be considered. Especially preoperative cholangitis in patients who are scheduled to curative resection for malignant tumors should treated as an oncologic emergency because it may increase postoperative septic complications and have adverse effects on cancer growth. In addition, it can occur as a complication associated not only with biliary obstruction but also with its drainage procedures, which provokes bacterial colonization. In the clinical practice of managing these patients, several clinical questions can be provoked: 1) Who are patients with high risk of AC secondary to malignant biliary obstruction? 2) What is the indication of preoperative biliary drainage? 3) What is the most appropriate preoperative biliary drainage in effectively relieving biliary obstruction as well as avoiding the cholangitis related to drainage? 4) What is the optimal duration and route of antibiotic therapy? 4) When is the safe timing of operation after treatment of AC? 5) Should antibiotics be administered postoperatively? The results of reports related to these clinically relevant questions remain inconclusive as to date. Therefore, the treatment guideline with a more focus on AC secondary to malignant biliary obstruction should be established to suggest the proper management of these patients. |
