Percutaneous cholecystostomy for acute cholecystitis in critically ill patients.

BACKGROUND: Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity or mortality in critically ill or elderly patients. METHODS: We report a retrospective study of ultrasonography-guided percutaneous cholecystostomy (USGPC) performed between 1988 and 1994 in 41 patients (mean age, 77.8 years; range, 42-95 years) as an alternative to surgery. RESULTS: Five patients (12.2%) died in the hospital, four (9.8%) subsequently underwent operation without complications, six (15%) had a recurrence of cholecystitis between 3 and 24 months after withdrawal of drainage, and 26 patients are cured without recurrence after a mean follow-up of 33 months (range, 3-67 months). CONCLUSIONS: USGPC appears to be the treatment of choice for high-risk patients, especially those with postoperative cholecystitis, severe acute calculous pancreatitis, or total parenteral nutrition.

[Retroperitoneal perforations of the colon. Apropos of 2 cases]. / Perforations coliques rétropéritonéales. A propos de 2 cas.

The retroperitoneal perforation of the colon is rare and our observations illustrate its two modes of revelation: a retroperitoneal suppuration; it must be traited quickly in order to decrease the mortality. Note that the abscess of the thigh is exceptional. Retroperitoneal perforations during colonoscopy whose treatment (initially medical) become surgical if there is no clinical improvement.

[Echo-guided percutaneous cholecystostomy in the treatment of acute cholecystitis. Apropos of 41 cases]. / Cholécystostomie percutanée échoguidée dans le traitement de la cholécystite aiguë. A propos de 41 observations.

Differents studies note many complications of the traditional cholecystectomy for acute cholecystitis in critically ill and very old patients. We report a retrospective study of ultrasound-guided cholecystostomy as an alternative treatment avoiding surgery in 41 patients between April 1988 and January 1994. Mean-age was 77.8 years (42-95). Hospital mortality concerned five (12.2%) patients. Four (9.8%) required surgical procedure, all of them with simple post-operative course. Six (14.6%) had a recurrence between 1 and 67 months after the end of the drainage. Twenty-six patients are considered as healed, without recurrence, after a mean-follow-up of 33 months. The percutaneous echoguided cholecystostomy seems to be a treatment of choice for patients with a contraindication for a surgical procedure. This technic allows an efficient treatment in patients with post-operative cholecystitis.

[Prevention of infection of surgical wounds under experimental conditions]. / Profilaktika nagnoeniia operatsionnykh ran v éksperimente.

A method for creation of an experimental model of the operative wound suppuration is presented. The expediency to use the antiseptic preparations for prevention of suppuration of the deliberately infected operative wound has been proved. The best results were noted in using the antiseptics effective towards the given microflora. This confirms the necessity of individual choice of an antiseptic preparation.