title: Gallbladder sepsis after stent insertion for bile duct obstruction: management by percutaneous cholecystostomy.
abstract: Of 364 patients undergoing insertion of a biliary endoprosthesis in 1989, six (1.6 per cent) developed gallbladder sepsis. Three patients had cholangiocarcinoma, two had carcinoma of the pancreas and one had a benign biliary stricture. Two of the five patients with malignancy had gallbladder stones, and the patient with a benign stricture developed stones after 3 years of stenting. Three patients developed gallbladder sepsis early after endoprosthesis insertion (less than 6 days), while in the other three it occurred late (greater than 6 months). All six patients failed to respond to antibiotics and were successfully managed by percutaneous cholecystostomy; the patient with a benign biliary stricture also had cholecystolithotomy. The gallbladder drainage tubes were removed or became dislodged at intervals varying from 2 weeks to 6 months without complications. Percutaneous cholecystostomy is the treatment of choice for gallbladder sepsis unresponsive to antibiotics in patients with a biliary endoprosthesis in situ.
authors.affiliation: Department of Gastroenterology, Middlesex Hospital, London, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Ainley
authors.forename: S J
authors.initials: SJ
authors.lastname: Williams
authors.forename: A C
authors.initials: AC
authors.lastname: Smith
authors.forename: A R
authors.initials: AR
authors.lastname: Hatfield
authors.forename: R C
authors.initials: RC
authors.lastname: Russell
authors.forename: W R
authors.initials: WR
authors.lastname: Lees
mesh_terms: D002759:Adenoma, Bile Duct / Q000150:complications; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications; D002764:Cholecystitis / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D011183:Postoperative Complications / Q000601:surgery*; D015607:Stents