Acute obstructive septic cholangitis is also known as acute septic cholangitis. It is the most important and direct cause of death in biliary surgery patients, mostly secondary to bile duct stones and biliary ascariasis, and can be combined with bile duct cancer in a few patients in advanced stages. Symptoms: The onset of the disease is generally rapid, with sudden onset of persistent pain in the subxiphoid and/or right upper abdomen, accompanied by nausea and vomiting, followed by chills and fever, and jaundice in more than half of the patients. More than half of the patients have jaundice. Typical patients have abdominal pain, chills, fever, jaundice and other charcot triad signs, and even cyanosis, coma and even death. Treatment: The principle of treatment for acute septic cholangitis is to surgically relieve bile duct obstruction, reduce bile duct pressure and drain bile. The treatment plan should depend on the patient’s specific situation at the time of hospitalization. The disease should be treated surgically in a timely manner before severe shock or multiple organ failure occurs. Specific methods include: surgical choledochotomy with T-tube drainage, PTCD (percutaneous hepatic puncture for bile duct placement and drainage), ERCP (transduodenoscopic cholangiopancreatography with duct placement and drainage). 1, shock should be treated first, and attention should be paid to the prevention and control of acute renal failure; 2, correct metabolic acidosis, according to the results of blood biochemical examination, input appropriate amount of sodium bicarbonate; 3, choose broad-spectrum antibiotics intravenous drip, and then adjusted according to the results of bile and blood bacterial culture and antibiotic sensitivity determination; 4, give analgesics and antispasmodics, correct dehydration, intravenous administration of high-dose vitamin C and If the situation permits, fiberoptic duodenoscopy and nasobiliary drainage can be performed. After the above emergency treatment, the condition may stabilize, blood pressure is stable, abdominal pain is reduced, and body temperature is decreased. After the general condition improves, surgery will be performed at an optional stage. The basic method of surgery is common bile duct dissection and drainage. In cases with gallbladder pus and stones, gallstones can be removed and cholecystostomy can be performed at the same time, and then a second operation can be performed after the condition improves. It is advisable to explore the common bile duct first, remove the stones in the bile duct, and place a T-shaped drain. If the opening of the hepatic duct is obstructed, it must be enlarged or the stricture must be cut open. The stone above the stricture is removed as much as possible, and then one arm of the drainage tube is placed into the hepatic duct above the stricture in order to achieve adequate drainage. PTCD (percutaneous hepatic puncture for biliary drainage): Under the guidance of X-ray or ultrasound, a special puncture needle is used to penetrate the intrahepatic bile duct percutaneously, and then the contrast agent is injected directly into the bile duct to rapidly visualize the intra- and extrahepatic bile ducts, while biliary drainage is performed through the contrast tube. ERCP retrograde endoscopic cholangiopancreatography is performed by inserting a fiberoptic duodenoscope into the descending duodenum, finding the large duodenal papilla, inserting a plastic catheter into the biopsy duct to the opening of the papilla, injecting a contrast agent and then taking an x-ray to show the pancreaticobiliary duct. Based on this, minimally invasive treatment of biliopancreatic duct disease is performed. For this disease is the possibility of performing duodenal papillary sphincterotomy (EST), endoscopic nasal bile drainage (ENBD), and endoscopic internal bile drainage (ERBD).