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

ABSTRACT

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 cholecystectomydiabetes 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.