Cholangitis historical perspective

Dr. Jean-Martin Charcot, a French physician, is credited with discovering cholangitis in the late 19th century. He referred to the condition as “hepatic fever.” Charcot’s triad of fever, jaundice, and right upper quadrant abdominal pain is the classical presentation of cholangitis. By adding septic shock and mental status changes to the list of symptoms, Dr. B. M. Reynolds and Dr. Everett L. Dargan changed Charcot’s triad to Reynold’s pentad. Until 1968, the mainstay of treatment of cholangitis was surgery, with the exploration of the bile duct and excision of gallstones, until the advent of endoscopic retrograde cholangiopancreatography (ERCP).

• In 1877, at the Salpêtrière Hospital in Paris, France, Dr. Jean-Martin Charcot was first credited with describing cholangitis.^[1]
  • He initially referred to this condition as a triad of three symptoms: abdominal pain, fever, and jaundice.
• In 1959, American surgeon Dr. Benedict M. Reynolds ignited interest in the condition with his report with colleague Dr. Everett L. Dargan.^[2]
  • The report discussed how the condition was generally treated by surgeons, as an exploration of the bile duct and excision of gallstones.
  • Reynolds and Dargan recognized that septic shock and mental status changes portended a poor outcome.^[3][4][5][6]
    • The addition of these two symptoms gave rise to the Reynold’s pentad, which is commonly used in clinical practice nowadays.
  • In 1968, endoscopic retrograde cholangiopancreatography (ERCP) was first used for the diagnosis and management of acute cholangitis.
• In modern times, seventy to eighty percent of cases of acute cholangitis are resolved by antibiotics; some cases may require ERCP to achieve surgical decompression.^[1][7]

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