The use of computed tomography (CT) was investigated in 50 patients with recurrent pyogenic cholangitis, 22 of whom had undergone prior choledochoenterostomy or sphincteroplasty. A spectrum of pathologic features was noted, including intrahepatic ductal dilatation (n = 50), common duct dilatation (n = 34), strictures (n = 11), intrahepatic calculi (n = 37), common duct calculi (n = 15), pneumobilia (n = 26), segmental atrophy (n = 18), and splenomegaly (n = 7). Unilobar disease existed in 14 patients. The left lateral segment was predominantly affected, with ductal dilatation (n = 23) and segmental atrophy (n = 13). During acute exacerbation, additional manifestations were observed: ductal wall enhancement (n = 4), segmental parenchymal enhancement (n = 9), hepatic abscess (n = 9), and biloma (n = 2). CT enables sensitive, complete evaluation of this disorder. It is valuable when results of ultrasonography are non-diagnostic and for planning hepatic resection, evaluating associated mass lesions, and guiding complex interventional procedures.