Résumé
BACKGROUND/AIMS: Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity or mortality in critically ill or elderly patients. METHODS: We performed ultrasonography-guided percutaneous cholecystostomy under local anesthesia in 18 elderly or critically ill patients with suspected acute cholecystitis between 1996 and 1999. RESULTS: Among the 18 patients, 16 had cholecystitis(11 calculous and 5 acalculous); in 2 patients, the procedure was only diagnostic. In 13 of 16 patients with acute cholecystitis, immediate relief of symptoms and significant improvement of laboratory signs of cholecystitis occurred. Persistent signs of cholangitis due to combined common bile duct and intrahepatic duct stones lead to laparotomy in 2 patients. One of these patients died due to pneumonia. Among 13 patients with cholecystitis, 5 patients underwent elective cholecystectomy(4: calculous, 1: acalculous) in 5 and 7 postprocedure days. One laparoscopic cholecystectomy was performed in these patients in 3 months. There was no any operative complication in elective cholecystectomy for these patients. The other 8 patients are symptom-free with an intact gallbladder after mean follow-up period of 17 months. In 2 patients, postprocedure radiologic signs of right pleural effusion were noted but resolved in 10 days in both patients. In one patient minor bleeding was noted but improved by observation only. Mortality rate of a patient with cholecystitis, treated by percutaneous cholecystostomy, was 12.5 percent( 2 of 16). CONCLUSION: These results indicate that percutaneous cholecystostomy is an effective temporary measure in elderly or critically ill patients.