[Percutaneous gallbladder drainage a good treatment in patients with acute cholecystitis and and poor clinical status].
OBJECTIVE
To evaluate the results of ultrasound-guided percutaneous cholecystostomy in patients with increased surgical risk.


METHODS
University Hospital Rotterdam.


METHODS
Retrospective.


METHODS
24 patients with acute cholecystitis and an increased surgical risk were treated with ultrasound-guided percutaneous cholecystostomy. Cholecystostomy was successfully performed in all patients.


RESULTS
23 patients showed clinical and biochemical improvement within one week. Minor complications were encountered in three cases (12%) which were treated conservatively. 16 patients suffered from calculous cholecystitis. One patient died after the cholecystostomy from an aspiration pneumonia. Cholecystectomy was performed at a later stage in six patients. One of these patients died six days after surgery from a myocardial infarction. Seven patients had percutaneous or endoscopic therapy for gallstones. In two cases no further therapy for gallstones was performed. Eight patients had acalculous cholecystitis. Four patients, suffering from cholangiocarcinoma and malignant obstruction of the cystic duct, subsequently underwent cholecystectomy (two patients) and percutaneous sclerotherapy of the gallbladder (two patients). Percutaneous cholecystostomy alone sufficed for the four remaining patients with acalculous cholecystitis.


CONCLUSIONS
Percutaneous cholecystostomy for high-risk patients with acute cholecystitis is a low-invasive procedure with low morbidity and mortality. The catheter in the gallbladder offers diagnostic and therapeutic possibilities and does not interfere with cholecystectomy at a later stage. In some cases of acalculous cholecystitis drainage of the gallbladder is the only therapy needed.
Meijers
H
H
Afd. Radiodiagnostiek, Academisch Ziekenhuis Rotterdam-Dijkzigt.
van Overhagen
H
H
van Lanschot
J J
JJ
Laméris
J S
JS
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D002764:Cholecystitis / Q000628:therapy*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors