Abstract:

Introduction: Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. The most frequent causes of biliary obstruction are biliary calculi, benign biliary stricture, and malignancy. Case presentation: Here we report a case presented with septic shock and acute ascending cholangitis on top of an altered anatomy in the form of disruption of the head and Wirsung duct of the pancreas, complete avulsion of the CBD at the ampulla of vater and deformed duodenal bulb after an old road traffic accident sustained thirty-five years back. Initial resuscitation, antibiotic therapy with urgent decompression have been done. Definitive surgery has been performed in the form of dismantling of prior cholecystojejunostomy, exploration and resection of common bile duct with cholecystectomy and Roux-en-Y hepaticojejunostomy with adhesiolysis. Conclusions: 1. Definitive surgery remained the mainstay of treatment for extrahepatic biliary and pancreatic trauma to prevent future life-threatening complications. 2. MDT approach is the optimal choice for dealing with critically ill patients. 3. Utilization of the full capabilities of endoscopic and interventional radiology services deemed mandatory for urgent and timely management.