{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:54:14Z","timestamp":1791003254893,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    A 42\u2010year\u2010old antibiotic\u2010na\u00efve man with previous laparoscopic cholecystectomy and poorly controlled type 2 diabetes mellitus (HbA1c 9.7%) presented with Charcot's triad 7\u2009days after a formally documented normal hepatobiliary evaluation (alanine aminotransferase [ALT] 22\u2009U\/L; total bilirubin 0.7\u2009mg\/dL [12\u2009\u03bcmol\/L]; common bile duct [CBD] \u2264\u20095\u2009mm on ultrasound). Admission findings satisfied all three Tokyo Guidelines 2018 (TG18) diagnostic domains. Severity was Grade II on two of the five TG18 severity criteria\u2014leukocytosis (14.2\u2009\u00d7\u200910\n                    <jats:sup>3<\/jats:sup>\n                    \/\u03bcL) and hyperbilirubinaemia (26\u2009mg\/dL, 445\u2009\u03bcmol\/L); temperature (38.9\u00b0C), age (42\u2009years), and albumin (3.4\u2009g\/dL, 34\u2009g\/L) did not meet their thresholds, and no Grade III organ dysfunction was identified on the recorded variables. Grade II severity established the indication for early biliary drainage at presentation. Computed tomography (CT) showed only mild intrahepatic ductal dilatation with 3\u20134 hyperattenuating distal CBD filling defects (greatest \u22484\u2009mm) and no dominant calculus. Immediate endoscopic retrograde cholangiopancreatography (ERCP) was not feasible because of endoscopy\u2010suite and anesthetic availability; antimicrobial and supportive therapy continued, and persistent clinical and biochemical abnormalities at 48\u2009h (ALT 837\u2009U\/L; bilirubin 24\u2009mg\/dL, 410\u2009\u03bcmol\/L; C\u2010reactive protein 86\u2009mg\/L) reinforced the urgency of drainage during that interval. ERCP on Day 3, at the earliest available opportunity, showed macroscopic purulent bile at ductal entry, distal CBD filling defects, and copious biliary sludge on balloon sweep. Fever resolved within 24\u2009h, and hepatobiliary and inflammatory markers normalized by 3\u2009months (ALT 38\u2009U\/L; bilirubin 0.9\u2009mg\/dL, 15\u2009\u03bcmol\/L; C\u2010reactive protein &lt;\u20095\u2009mg\/L). This case illustrates that current severity, not antecedent normality or unimpressive imaging, should govern the timing of biliary drainage, and it reports transparently an interval to drainage imposed by resource availability.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.73674","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:35:37Z","timestamp":1791002137000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Current Severity Overrides Reassuring Findings:\n                    <scp>TG18<\/scp>\n                    \u2010Guided Biliary Drainage in\n                    <scp>ERCP<\/scp>\n                    \u2010Confirmed Purulent Cholangitis"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9721-6249","authenticated-orcid":false,"given":"Hatem Mousa","family":"Taha","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Palestine Medical Complex  Ramallah Palestine"},{"name":"Faculty of Medicine and Health Sciences An\u2010Najah National University  Nablus Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3972-9459","authenticated-orcid":false,"given":"Khaled Hatem","family":"Taha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences An\u2010Najah National University  Nablus Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.512"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.509"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.496"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553\u20102712.2002.tb01574.x"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.519"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010023\u201007981\u20107"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2005.40793.x"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478\u20103231.2011.02655.x"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1994.01420320055010"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102012\u2010302779"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010130\u20104\u2010199902160\u201000016"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.livres.2018.10.001"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.518"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.12.032"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.452"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.02.043"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.213.3.r99dc17831"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73674","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73674","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73674","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:35:45Z","timestamp":1791002145000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":17,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/ccr3.73674"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73674","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-06-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73674"}}