Homoeopathic Management of Acute Cholangitis in a Case of Adenocarcinoma of Gall Bladder with Metastasis: A Case Report

Abstract Acute cholangitis is a bacterial infection superimposed on an obstruction of biliary tree from a gall stone, neoplasm or stricture. The biliary obstruction is most commonly caused by choledocholithiasis benign or malignant stricture of the bile duct or hepatic ducts, pancreatic cancer, ampullary adenoma or cancer, porta hepatis tumour or metastasis, biliary stent obstruction (due to microbial biofilm formation, biliary sludge deposition and duodenal reflux of food content), primary sclerosing cholangitis and amyloid deposition in the biliary system. Classically, patients present with high fever persisting for more than 24 hours, abdominal pain and jaundice (Charcot's triad). The right upper quadrant abdominal (RUQ) pain is generally mild. When the cholangitis becomes more severe, patients become hypotensive and confused (Reynold's pentad). Charcot's triad has low sensitivity (26.4%) and high specificity (95.9%). Although the presence of Charcot's triad is suggestive of acute cholangitis, it is not diagnostic. Charcot's triad is present in 26.4 to 72% of patients with acute cholangitis. TG07 diagnostic criteria for acute cholangitis also do not have enough sensitivity and specificity and its severity criteria are also not suitable for clinical use. Antibiotics, intravenous fluid, Vitamin K supplementation and biliary drainage are the options available in conventional mode of treatment for acute cholangitis. Presented here is one case report of acute cholangitis in a patient of adenocarcinoma of gall bladder with metastasis. The case was treated using classical method of homoeopathy with complete improvement in clinical and laboratory parameters of acute cholangitis.