Four patients with acute cholangitis were seen, all of whom died following cholecystostomy or cholecystoduodenostomy. The diagnosis of cholangitis is frequently missed in elderly patients with jaundice and sepsis. Cholecystostomy, in the face of cholangitis without documentation of patency of the cystic duct, is uniformly fatal. Diagnosis of cholangitis should be confirmed and immediately followed by adequate common duct drainage. Finally, immediate reoperation, rather than antibiotic manipulation, is advised to establish common duct drainage in those patients who do not respond to cholecystostomy within 24 hours.
(JAMA 235:2412-2413, 1976)