Percutaneous cholecystostomy in critically Ill patients

Abstract

Sixteen critically ill patients underwent percutaneous cholecystostomy because of suspected acute cholecystitis. The procedure was technically successful, although 11 of 16 patients died subsequently because of various complications of their underlying primary disorders. We reviewed this series to reassess the value of percutaneous cholecystostomy. Four of 11 patients with definite acute cholecystitis (group 1) were cured by this technique, but three required surgery because of gallbladder wall necrosis. Two of these were among four cases which had demonstrated pericholecystic fluid collections on computed tomography (CT) or ultrasound of the abdomen. There were also five patients (group 2) in whom acute cholecystitis or its relationship to patients' symptoms were not fully determined, and four of them did not improve after percutaneous cholecystostomy. We conclude that this technique has a lower success rate in critically ill patients than reported previously.

Prevalence and Significance of Gallbladder Abnormalities Seen on Sonography in Intensive Care Unit Patients

“…Similarly, intramural wall lucencies, defined as irregular discontinuous lucent and echogenic bands in the gallbladder wall [1], were not seen in either of the two patients who developed acalculous cholecystitis, but were seen in 15% of patients who did not develop acalculous cholecystitis. Localized pericholecystic fluid (defined as fluid around the gallbladder alone, not associated with ascites) has been reported to show some specificity for acute cholecystitis [3,8]; however, in our study, this fluid was found in 19% of patients, none of whom developed acalculous cholecystitis.…”

“…Multiple static images were obtained in the sagittal and transverse planes of the gallbladder, and wall thickness was measured from transverse images relative to the long axis of the gallbladder. The images were examined together by two radiologists for sonographic features consistent with acalculous cholecystitis features that have been described: gallbladder wall thickening, gallbladder distention, intramural gallbladder wall lucencies (striated gallbladder wall), pericholecystic fluid, gallbladder sludge, and the presence of a sonographic Murphy's sign [1][2][3][4][5][6][7][8][9]. Gallbladder wall thickening was defined as a transverse wall measurement adjacent to the liver and perpendicular to the sonography beam of greater than 3 mm.…”

Percutaneous Cholecystostomy Versus Laparoscopic Cholecystectomy in Patients With Acute Cholecystitis and Failed Conservative Management

“…[21][22][23][24][25][26] In the present study the mortality rate in PC group was 13%, which was higher than in the LC group but not statistically significant. [21][22][23][24][25][26] In the present study the mortality rate in PC group was 13%, which was higher than in the LC group but not statistically significant.…”

Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients

“…Previous studies have reported response rates of 63-93% [24,25] and 80% [25], respectively. AAC has been associated with a high incidence of gallbladder wall gangrene [9,14,25,26], in which a non-surgical treatment could be insufficient and an explanation of a lower response rate. The finding of pericholecystic fluid on Us could be an indicator of a gangrenous gallbladder [25] and has been found to be a negative predictor for response by some authors [25,26].…”

“…AAC has been associated with a high incidence of gallbladder wall gangrene [9,14,25,26], in which a non-surgical treatment could be insufficient and an explanation of a lower response rate. The finding of pericholecystic fluid on Us could be an indicator of a gangrenous gallbladder [25] and has been found to be a negative predictor for response by some authors [25,26]. Lo et al [25] suggested that surgical intervention should be 215 this specific case, the gallbladder was punctured transperitoneally, because of individual anatomy of the liver.…”