Acute suppurative cholangitis secondary to malignant obstruction.

Acute suppurative cholangitis due to malignant obstruction of the distal biliary tract is uncommon. Only 16 cases have been documented in the English literature (excluding patients with previous surgery for their malignant tumours). The authors add five new cases and discuss the clinical characteristics of the process. The possible relation of endoscopic retrograde cholangiography to the pathogenesis of acute suppurative cholangitis in these patients is presented and prophylactic antibiotic therapy is advised once obstruction is demonstrated. Immediate operative decompression of the obstructed common bile duct as a life-saving procedure is of prime importance, in preparation for a later palliative or curative surgical procedure.