Abstract: Objective: To explore the clinical features and methods for treatment of acute cholangitis of severe type(ACST) in the aged.Methods: Forty-six aged patients with ACST treated in our hospital from 1994 to 2003 were analyzed retrospectively.Results: Twelve patients died,with a mortality of 26.1%,7 of whom died of toxic shock(58.3%) and 5 died of multiple organ failure(41.7%).Conclusions: The ACST in the aged patients has the characteristics of lack of typical clinical manifestations,more coexisting diseases, toxic shock,electrolyte disturbance and multiple organ failure.Good pre-operative preparations,choice of operation time and procedure,good postoperative management are the key to the success of the operation.