Percutaneous cholecystostomy for acute cholecystitis in high-risk patients

Klimberg, Suzanne; Hawkins, Irvin F.; Vogel, Stephen B.

doi:10.1016/0002-9610(87)90212-1

Cited by 65 publications

(35 citation statements)

References 21 publications

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“…We found an equal incidence in males and females, although the sex ratio for this disease remains controver sial [3,6,9,11]. Pancreatitis and obesity, considered pos sible risk factors, were not statistically more frequent in the group aged 80 years or more in comparison to the group below 80 years of age.…”

Section: Discussionmentioning

confidence: 80%

“…Until more data on nonoperative treatment of acute cholecystitis in elderly patients become available, the rec ommendation for early surgery remains valid in all but poor-risk patients belonging to ASA categories IV and V. For patients who are subject to increased operative risk, two alternative treatments are recommended [11,13]: (a) percutaneous transhepatic cholecystostomy under sonographic control; this procedure is suitable for pa tients with empyema and without choledochal pathology; (b) endoscopic papillotomy for patients with septic chol angitis and enlarged choledochus. Laparoscopic cholecystectomy which is the treatment of choice for cholelithiasis, and for most patients with acute cholecystitis, is still a debatable procedure for elder ly patients.…”

Section: Discussionmentioning

confidence: 99%

“…In women, the incidence of choleli thiasis increases rapidly after the age of 30. The disease occurs in approximately 30% or more of septuagenarians whom percutaneous cholecystostomy is recommended [11]. The aims of the present study were to analyze the treatment methods for cholecystitis in patients 80 years old or more -a rapidly growing group -and to compare our results with those in a younger patient group.…”

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confidence: 99%

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Surgery for Acute Cholecystitis in the Elderly (> 80 Years)

Landau¹,

Watemberg²,

Deutsch³

et al. 1994

Dig Surg

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In the last 15 years we operated on 618 patients for acute cholecystitis, of whom 60 were 80 years of age or more. Most of the ever-increasing number of patients within the hospital population who suffer from this disease belong to the over-80 age-group. Acute biliary complications are the major cause of serious morbidity in these patients. The major conclusions of the study were: (1) Acute cholecystitis in patients aged 80 years or more has increased by almost 300% over the last 15 years. (2) Comparison of patients aged 80 years or more with a younger patient group showed that the former had a higher incidence of diabetes mellitus (33.3 vs. 5.5%, p < 0.001), jaundice (26.6 vs. 14.8%, p < 0.001), common bile duct stones (41.6 vs. 21.1%, p < 0.001) and gangrenous changes in the gallbladder wall (38.3 vs. 24.9%, p < 0.05). Older patients also had higher mortality (11.6 vs. 1.6%, p < 0.001). The results in this series show a higher rate of risk factors in aged patients suffering from cholecystitis combined with a higher rate of mortality. It seems that a prompt operative approach could lessen the grave results in this group. Alternative nonsurgical methods should, at present, be restricted to very poor-risk patients as well as patients refusing surgery.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Surgery for Acute Cholecystitis in the Elderly (> 80 Years)

Landau¹,

Watemberg²,

Deutsch³

et al. 1994

Dig Surg

View full text Add to dashboard Cite

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“…PC has been documented as a safe and effective procedure for the initial treatment of acute cholecystitis in high-risk patients [8, 9, 10, 11]. The procedure can easily be performed on an emergency basis under local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous cholecystostomy (PC) has been suggested as being a safe and effective procedure for resolving acute cholecystitis in high-risk patients [8, 9]. The procedure offers a viable alternative to surgical cholecystostomy in the decompression of distended inflamed gallbladder, a way to interrupt the natural course of the disease.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Cholecystostomy as an Initial Treatment for Acute Cholecystitis in Elderly Patients

Lee¹,

Wong²,

Cheng³

et al. 1998

Dig Surg

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Background/Aims: Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of servere co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we performed ultrasound-guided percutaneous transhepatic cholecystostomy (PC) on elderly patients with acute cholecystitis for both initial treatment and subsequent diagnosis of their biliary tract disorders. Methods: Those being more than 70 years old, had acute episode of cholecystitis for more than 48 h and still had positive Murphy’s signs and distended gallbladders were candidates for ultrasound-guided PC. Results: Forty-two elderly patients underwent ultrasound-guided PC. Once the condition of each patient showed signs of improvement and stability, cholangiography was performed via PC tube. The results of the cholangiography showed 20 patients with gallbladder stones, 16 with common bile duct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients with acalculous cholecystitis had the PC tube removed 3 weeks later, without further surgery. Two patients had gallbladder stones removed by choledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occurred in 5 patients (11.9%), no instance of operative mortality was found. Conclusion: Our findings lead us to conclude that the use of PC in the early treatment of acute cholecystitis in elderly patients can decrease postoperative morbidity and mortality.

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