Beneficial Effect of Cholecystography following PGBD for Complicated Acute Cholecystitis: Detection of Unsuspected CBD Stone

ABSTRACT

PURPOSE: Frequency of combined CBD stones on cholelithiasis has been known to range 5~20% in several reports, and diagnostic tools are USG, MDCT, MRCP and ERCP. Predictive factors of CBD stone for cholelithiasis were diameter of CBD, elevated liver enzyme, multiple small sized GB stones and concurrent pancreatitis. However, unsuspected CBD stone for acute cholecystitis is troublesome for patients and surgeons. METHODS: We retrospectively reviewed Percutaneous gallbladder drainage (PGBD) for acute complicated cholecystitis from October 1996 to October 2006. Indications for PGBD are clinical symptoms (sepsis) & signs of peritonitis and radiologic findings such as GB empyema, gangrenous cholecystitis and pericholecystic fluid collection. Total laparoscopic cholecystectomy was 1,357 cases, and PGBD for acute complicated cholecystitis was 13.8%. RESULTS: Combined CBD stone rate was 13.6%. Whereas, unsuspected CBD stone was 0.5% (9 cases), 7 in calculous and 2 in acalculous cholecystitis. No. of stone was 1 in 7 cases, 2 in 1 case and 3 in 1 case. Size of stone was less than 5 mm in all cases. Diameter of CBD was not increased in all cases (less than 1 cm) and liver enzymes showed no elevation in all cases. Management for unsuspected CBD stone was preoperative endoscopic lithotripsy in 8 cases and postoperative fluoroscopic lithotripsy in 1 case. CONCLUSION: Cholecystography following PGBD for acute complicated cholecystitis is a useful diagnostic modality for detection of unsuspected CBD stone.