Percutaneous cholecystostomy: A valuable technique in high-risk patients with presumed acute cholecystitis

Abstract

Percutaneous cholecystostomy offers a potentially important therapeutic modality for critically ill patients with acute cholecystitis who represent a high risk for general anaesthesia. The aim of the study was to assess experience with percutaneous cholecystostomy in resolving the acute episode of cholecystitis without operative intervention. Twenty-two consecutive patients with a clinical diagnosis of acute cholecystitis underwent the procedure. All were at high risk for general anaesthesia, and all but one developed cholecystitis while hospitalized for another co-morbid condition; 14 were in an intensive care unit. Twenty-one of the 22 patients proved to have acute cholecystitis (11 acalculous, ten cholelithiasis). There were no acute technical complications. Toxaemia resolved in 17 of the 21 patients with acute cholecystitis. Acute cholecystitis failed to resolve in three patients; all died within 48 h from overwhelming generalized sepsis. One patient required emergency cholecystectomy for bile peritonitis when the cholecystostomy catheter became dislodged 24 h after placement. The 60-day mortality rate for the acalculous and calculous patient groups was 55 and 20 per cent, respectively. Only three interval cholecystectomies have been performed at a mean follow-up of 19 months. In conclusion, percutaneous cholecystostomy may be the procedure of choice for the management of acute cholecystitis in the very high-risk critically ill patient. If symptoms fail to resolve quickly, ongoing sepsis, cholangitis or gallbladder necrosis should be suspected.

Evidence-based clinical practice guidelines for cholelithiasis 2016

“…One patient underwent cholecystectomy 1 month later, but the other three patients, who were asymptomatic, refused cholecystectomy despite the physician's recommendation. In another report, PTGBD was performed in 21 acute cholecystitis patients with general anesthesia risk [116]. Three patients died of sepsis within 48 h without any appreciable improvement.…”

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

“…We had only one leak that resulted in a worsened septic state and urgent cholecystectomy, something also experienced by others [20]. Our experience of significantly more leaks in case of cystic duct obstruction demonstrated at cholangiography may be worthy of notice, but was not observed by Borzellino et al [23]who observed a 5% obstruction rate.…”

“…An established leak or catheter dislodgement can be treated by catheter withdrawal or placement of another catheter, usually without dire consequences [19, 20]. We had only one leak that resulted in a worsened septic state and urgent cholecystectomy, something also experienced by others [20].…”

“…Failure is principally associated with catheter dislodgement and bile leak but severe complications are rare [20, 22, 23]. The failure rate has been reported to be below 6% and the incidence of catheter displacement 5–18% [20, 23].…”

“…Since the first PTBD performed by Radder [18]in 1980 for gallbladder empyema, it has become a useful alternative to operative treatment in high-risk patients with acute calculous cholecystitis [19, 20, 21, 22, 23]. Failure is principally associated with catheter dislodgement and bile leak but severe complications are rare [20, 22, 23].…”