ACUTE obstructive cholangitis is a clinical syndrome characterized by right upper abdominal pain, jaundice, chills with fever (Charcot's triad), central nervous system signs such as lethargy, disorientation, or coma, combined with septic shock. Reynolds and Dargan in 1959 emphasized this clinical pentad as a distinct entity which if untreated results in a high mortality rate.1 An awareness of this syndrome leading to early recognition and prompt surgery will offer the best opportunity for survival. Acute inflammation of the biliary tree has been recognized since Charcot's original description in 1877.2 Osler in 1890 stressed that Charcot's fever was irregular and of short duration.3 In 1899 in necropsy studies Rogers recognized the role of surgical intervention in acute suppurative cholangitis.4 He unsuccessfully performed surgical decompression of the common duct by utilizing a glass tube on a patient with this disease. In 1940 Cutler and Zollinger stressed the need