Complications and Late Outcome following Percutaneous Drainage of the Gallbladder in Acute Calculous Cholecystitis

Abstract

Background: Acute septic cholecystitis (AC) remains a difficult problem in patients with coexisting severe illness, and ultrasonographically guided percutaneous puncture and drainage of the gallbladder (PTBD) may be an alternative treatment in this context. Setting: University Hospital, Norway. Methods: Retrospective study of the safety and efficacy of this approach in 86 consecutive patients treated from 1992 to 1999. Results: Five patients died. Drainage did not seem to influence the condition in these patients, who were drained for a mean of 8 days after admission compared to 4 days for the survivors (p = 0.01), and had a higher S-bilirubin on the day of the drainage, 46 and 29 µmol/l (p = 0.05), respectively. Seven patients had an intraperitoneal bile leak and 2 had worsening septicemia. One of these patients had both, and the gallbladder was removed. An open cystic duct demonstrated at catheter cholangiography was associated with a bile leak in 3 (4%) of 76 patients as opposed to 4 (40%) of 10 patients with obstruction (p = 0.001). Only 60 patients survived another 6 months because of general debility and other diseases. Twenty-seven (45%) of these were asymptomatic during follow-up. Twenty-eight (47%) of the remaining patients had at least one recurrent episode of AC. One patient who was readmitted due to AC had urgent cholecystectomy and 8 others had elective cholecystectomy during follow-up for a total cholecystectomy rate of 12%. A common bile duct stone was demonstrated in 4 patients after ERCP and indicative signs were found in another 5 (10%). Conclusions: PTBD remains a good option in patients with septic AC who have severe coexisting disease and may be too ill to undergo an operation. It may not be necessary to remove the gallbladder in 45% or more of the patients as many remain asymptomatic after PTBD.

Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: Non-operative management is an option in some patients

“…This series was comparable with ours for gender ratio. In a study of severe AC treated with percutaneous gallbladder drainage, 30% died within another 6 months because of severe co-morbidity [21].…”

Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines

“…Cholecystostomy was a common form of treatment in 1970 and before, and the most common cause of death during that period was pneumonia and sepsis . Currently, the major causes of death following cholecystostomy include malignant tumor, respiratory failure, and cardiac failure ,…”

Validation of Tokyo Guideline 2013 as Treatment of Acute Cholecystitis by Real World Data

“…The general physical condition of the elderly patients in the present study did not allow surgical intervention at the time of presentation [2][3][4]. Hence, cases that did not respond to antibiotics alone were treated with PTGBA or PTGBD, as they are reportedly good options for the treatment of acute cholecystitis in elderly patients [11][12][13][14]. Although the present study was not a prospective, randomized, controlled study, it was fairly conclusive in several aspects.…”