From the Guidelines
Charcot triad is a critical set of symptoms that indicates acute cholangitis, a life-threatening infection of the bile ducts, and prompt recognition and treatment are essential to prevent high mortality rates. The three components of Charcot triad are right upper quadrant abdominal pain, jaundice (yellowing of the skin and eyes), and fever with chills 1. According to the 2024 clinical practice guideline update by the Infectious Diseases Society of America, the diagnosis of acute cholangitis should include clinical signs, laboratory findings, and imaging findings, with CT with IV contrast being the preferred imaging modality 1.
When a patient presents with all three symptoms, it strongly indicates biliary obstruction with subsequent infection, typically caused by gallstones blocking the common bile duct. However, the complete triad is only present in about 50-70% of cholangitis cases, so clinicians should maintain suspicion even when only one or two components are present. The most important predisposing factor for acute cholangitis is biliary obstruction, and establishing successful biliary drainage is critical in the treatment of biliary sepsis 1.
Key aspects of treatment include:
- Prompt initiation of antimicrobial therapy, with appropriate antibiotics administered within 1 hour of diagnosis in patients presenting with sepsis, and within 6 hours of diagnosis in less severe cases 1
- Intravenous fluids and correction of coagulopathies
- Biliary decompression through endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage, or surgery. The condition can rapidly progress to septic shock if left untreated, with mortality rates approaching 100% without intervention, making rapid recognition of this triad crucial for patient survival.
From the Research
Definition of Charcot Triad
- Charcot triad is a set of three common symptoms associated with acute cholangitis, which is an infection of the biliary tree 2, 3, 4.
- The three symptoms that make up Charcot triad are:
- Fever
- Jaundice
- Abdominal pain
Clinical Presentation and Diagnosis
- Acute cholangitis is a life-threatening condition that requires prompt recognition and treatment 4, 5.
- The diagnosis of acute cholangitis is commonly made by the presence of clinical features, laboratory tests, and imaging studies 2, 3, 4.
- The Tokyo Guidelines emphasize the importance of clinical presentation, laboratory blood results, and diagnostic imaging in the diagnosis of acute cholangitis 4.
Treatment and Management
- The treatment modalities for acute cholangitis include administration of intravenous fluids, antimicrobial therapy, and prompt drainage of the bile duct 2, 3, 4, 5.
- Available drainage options include endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, endoscopic ultrasound, and open surgical drainage 4, 5.
- The American Society for Gastrointestinal Endoscopy's (ASGE) Standards of Practice Committee suggests endoscopic rather than percutaneous drainage and biliary decompression within 48 hours 5.