Management

Treatment is prompt intravenous fluid resuscitation, antibiotics directed against bacterial flora, and intensive observation of the patient. If a patient presents with septic shock, hemodynamic monitoring should be initiated. Patients who present with shock due to sepsis have an approximately 25% mortality rate. After initial resuscitation, transhepatic biliary drainage or endoscopic sphincterotomy and stone extraction or stent placement should be performed as indicated by the cause of the obstruction.

Emergency surgical decompression and common bile duct exploration are generally reserved for patients in whom PTC or ERCP has failed. After recovery from this illness, definitive surgery to correct the cause of obstruction can be performed (cholecystectomy for calculi, resection for malignancy, bile duct drainage procedure for strictures, etc.). In patients at high operative risk, palliation can be achieved with stenting of a tumor or stricture.

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