Percutaneous Cholecystostomy for Gallbladder Perforation: Early Response and Final Outcome in 10 Patients

PURPOSE: To evaluate the efficacy of percutaneous cholecystostomy (PC) as a therapeutic maneuver for patientswith spontaneous gallbladder (GB) perforation. MATERIAL AND METHODS: Ten patients with acute cholecystitis andsuspected GB perforation underwent emergency PC; perforation was documented by means of ultrasound, computedtomography, and/or fluoroscopy. All patients but two had a variety of high risk factors for open cholecystectomy:diabetes mellitus (n=2), cardiac disease (n=2), acute renal failure (n=1), liver cirrhosis (n=1), overwhelmingsepsis (n=1), and age over 80 (n=1). All percutaneous cholecystostomies were performed with ultrasound guidanceand preferably via the transhepatic route. A favorable response to PC was defined as an improvement in clinicalsymptoms and signs or reduction in fever, and return of the WBC to normal within 72 hr of the procedure. RESULTS:All procedures were technically successful, and no major procedure-related complications occurred. Eight patients(80%) responded favorably to PC. One, who did not respond, underwent emergency cholecystectomy next day due toworsening peritonitis, and the other who failed to respond within 72 hr showed delayed response after drainage ofa coexistent liver abscess at seven days after the procedure. A patient who responded to PC experienced catheterdislodgement four days after the procedure but reinsertion was not required. Five of eight patients who respondedpositively underwent elective cholecystectomy after the improvement of clinical symptoms, and the three remainingpatients improved without further surgery. CONCLUSION: For the treatment of patients in whom GB perforation issuspected, PC is a safe and effective alternative to surgical cholecystectomy.

Percutaneous Cholecystostomy at the Community Hospital: Value Evaluation

PURPOSE: To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. MATERIALS AND METHODS: Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalculous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy: liver cirrhosis (n=2), diabetes mellitus (n=3), cardiac disease (n=3), underlying malignancy (n=2), pulmonary dysfunction (n=1), septic cholangitis (n=5), and old age (n=2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. RESULTS: All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion (n=2) and procedure failure (n=1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered: catheter dislodgment (n=3), and significant abdominal pain during the procedure (2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients (94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. CONCLUSION: Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.

Percutaneous Cholecystostomy : 60 Cases of Experience

PURPOSE: To review the effectiveness and complication of percutaneous cholecystostomy(PCCS). MATERIALS AND METHODS: We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acutecholecystitis were as follows : acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops(n=3), GBempyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy :underlying malignancy(n=13), severe trauma(n=2), liver cirrhosis(n=3), diabetes mellitus(n=6), end stage renal disease(n=3), cardiac disease(n=3) and others(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. RESULTS: The cholecystostomy was successfully in 59 patients, and failed in 1 patients. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows : bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occured in most patients. Emergency operation was done in one patient who developed bile peritonitis. DISCUSSION: Cholecystostomy is effective and safe, especially incases of in operable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitiute surgical cholecystostomy.