# Percutaneous biliary drainage: a superior option in select cases of acute cholangitis: a case report

## TL;DR

Percutaneous biliary drainage can be a life-saving alternative when endoscopic treatment fails in acute cholangitis.

## Contribution

This case report highlights the effectiveness of percutaneous biliary drainage in high-risk patients with failed endoscopic treatment.

## Key findings

- PTBD under local anesthesia improved clinical outcomes in a high-risk patient with acute cholangitis.
- The patient showed significant recovery with normalized bilirubin and coagulation after PTBD.
- Follow-up confirmed good tolerance of the drainage and successful recovery.

## Abstract

Acute cholangitis is a severe, potentially life-threatening condition, frequently occurring post-ERCP. While endoscopic drainage is the preferred first-line treatment, percutaneous biliary drainage (PTBD) is a crucial alternative in select cases. We present a 55-year-old patient with prior left hemicolectomy and liver metastasis treatment developed acute cholangitis following failed ERCP stent placement, leading to rapid deterioration. Due to high anesthetic risk, ultrasound-guided PTBD with an 8 Fr pigtail catheter was performed under local anesthesia, resulting in significant clinical improvement. Broad-spectrum antibiotics targeted Escherichia coli. The misplaced stent was subsequently replaced, and the patient was discharged on postoperative Day 9 with normalized bilirubin and coagulation. Follow-up confirmed good drain tolerance and recovery. This case underscores PTBD’s critical role when endoscopic drainage fails. A multidisciplinary approach and early intervention are essential to improving outcomes in acute cholangitis management.