Cholangitis and choledocholithiasis

The prevalence of cholangitis and choledocholithiasis increases with age in all populations. Age-related changes have relevant implications in the diagnosis and management of these conditions. In this chapter, we examine the peculiarities of choledocholithiasis and acute cholangitis in the elderly. As for most acute abdominal conditions, the risk of erroneous or delayed diagnosis is high in aged patients, due to their clinical characteristics and age-related changes in the physiological responses to sepsis and inflammation. The higher risk that age and frailty imply stresses the importance of less invasive techniques for the clearance of the common bile duct obstruction. We examine the literature's best evidence about the management of these conditions in the older adults. We also analyze the role of minimally invasive surgery in the treatment of the clinical conditions of the frailer and older patients.