Complicated Cholangitis Due to Post-ERCP Biliary Stone Impaction: A Case Report

Acute cholangitis is a serious medical and surgical emergency, usually caused by obstruction of the biliary tract, most often by stones. We present the case of a 47-year-old male with a biliary stent left in place for over two years, admitted with a clinical picture of complicated cholangitis: jaundice, fever, cholestatic syndrome, and general deterioration. Radiological investigations revealed a biliary stone impaction with biliary dilation. Two attempts at endoscopic retrograde cholangiopancreatography (ERCP) failed. The patient underwent surgical management involving removal of the obstructed stent and stones, and placement of biliary drainage using a Kehr T-tube, Delbet drain, and Salem tube. Intraoperative isolation of Clostridium perfringens prompted targeted antibiotic therapy. Postoperative recovery was uneventful. This case highlights the importance of appropriate follow-up in patients with biliary stents and underscores the essential role of surgery in the event of endoscopic failure or severe infectious complications.