Laparoscopic approach in gastrointestinal emergencies

Table 2 Recommended treatment for acute cholangitis by severity

Grade	Management
Grade I	Initial medical management suffices in a majority of patients. Patients who do not respond to initial treatment undergo endoscopic, percutaneous or surgical drainage of bile ducts[28]
Grade II	After initiating medical treatment, patients undergo endoscopic, percutaneous or surgical T-tube drainage to avoid a deterioration of their condition
Grade III	Management entails organ supportive treatment together with urgent drainage of bile ducts. Once the patient is stable, endoscopic drainage must be performed. Percutaneous transhepatic cholangiography is indicated when the papilla is inaccessible and as a third-line approach when drainage is not possible or is contraindicated