When Current Severity Overrides Reassuring Findings: TG18-Guided Biliary Drainage in ERCP-Confirmed Purulent Cholangitis.

Hatem Mousa Taha, Khaled Hatem Taha

A 42-year-old antibiotic-naïve man with previous laparoscopic cholecystectomy and poorly controlled type 2 diabetes mellitus (HbA1c 9.7%) presented with Charcot's triad 7 days after a formally documented normal hepatobiliary evaluation (alanine aminotransferase [ALT] 22 U/L; total bilirubin 0.7 mg/dL [12 μmol/L]; common bile duct [CBD] ≤ 5 mm on ultrasound). Admission findings satisfied all three Tokyo Guidelines…