ABSTRACT
The Cholecystectomy is the treatment of choice in patients with acute cholecystitis, but non-surgical gall stone therapies, such as a percutaneous cholecystostomy (PC) should be attempted in high risk critically ill patient with acute cholecystitis. Forty critically ill patients with complicated medical and surgical problems underwent an emergency PC at kwanju christran Hospital between 1993 and 1996. Diagnosis were made based on clinical and sonographic findings. The PCs were performed for patients with septic shock (9 cases), severe pain due to gall bladder empyema (9 cases), severe medical problems with acute cholecystitis (16 cases), a previous operation history (3 cases), and refusal of surgery (3 cases). The PCs were successfully performed under ultrasound guidance, and symptoms of patients were improved within several days after the PC. There were no immediate technical complications. We measured the arterial blood gas and analyzed of several factors influencing the acid-base change before and after the PC. The values of the pH and the PCO2 changed with an increasing WBC count, the presence of jaundice, a positive blood culture, a decreasing platelet count, and hypotension but returned to normal within several days after the PC. Although we can not attach statistical significance to the findings, we found that the acid-base balance changed with severe acute cholecystitis, as well as with septic shock and that the clinical symptoms and hemodynamics were improved by the PC. In conclusion, a PC as a nonsurgical management may be the procedure of choice for nonsurgical management of high-risk patients with acute cholecystitis, and as a definitive treatment, a laparoscopic or open cholecystectomy should be performed when symptoms are improved and the patients become stable.