title: Percutaneous transhepatic cholecystostomy for acute complicated calculous cholecystitis in elderly patients.
abstract: OBJECTIVE
  To assess the immediate and long-term outcomes of elderly patients with acute complicated cholecystitis treated by percutaneous cholecystostomy. To assess the results of bile cultures obtained in this group of patients.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Thirty-two patients, with a mean (+/- S.D.) age of 78 +/- 8 years (range, 58-92 years), and who presented with acute cholecystitis complicated by empyema formation. Sixty-six percent had associated disorders, which rendered them at high risk for surgical intervention.
  
  
  METHODS
  Percutaneous transhepatic catheter drainage of the gallbladder, with a mean drainage time of 20 days (range 0-84 days). In addition, endoscopic sphincterotomy with removal of common bile duct stones was performed in six patients and percutaneous aspiration of an associated liver abscess in four cases.
  
  
  RESULTS
  Percutaneous cholecystostomy was followed by rapid regression of clinical symptoms and of radiologic abnormalities in all patients. Sixteen cases (50%) underwent elective cholecystectomy 1-12 weeks after cholecystostomy. One of them died of aspiration pneumonia, whereas 15 had no post-operative problems and were discharged 9 days (mean) after surgery. Forty-four percent (14/32) were considered inoperable: they remained completely free of biliary symptoms and died of unrelated illness (22%) after a mean follow-up of 6 months (range, 1-22 months) or are still alive (22%) with a mean follow-up of 15 months (range, 5-36 months). Bile cultures were positive in 75% of the patients. Escherichia coli, other aerobic Gram-negative micro-organisms, and anaerobic bacterial species accounted for 35% (16/46), 28% (13/46), and 20% (9/46) of the isolated bacteria, respectively. All aerobic Gram-negative species tested in vitro were susceptible to gentamicin and to temocillin.
  
  
  CONCLUSIONS
  Percutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly high-risk patients with acute cholecystitis complicated by empyema formation. It can be followed by elective cholecystectomy, if possible, or by expectant conservative management in patients who are inoperable because of systemic disease.
authors.affiliation: Department of Internal Medicine, UZ Gasthuisberg, K.U. Leuven, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Van Steenbergen
authors.forename: H
authors.initials: H
authors.lastname: Rigauts
authors.forename: E
authors.initials: E
authors.lastname: Ponette
authors.forename: W
authors.initials: W
authors.lastname: Peetermans
authors.forename: W
authors.initials: W
authors.lastname: Pelemans
authors.forename: J
authors.initials: J
authors.lastname: Fevery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001660:Biliary Tract Diseases / Q000150:complications* / Q000382:microbiology; D002764:Cholecystitis / Q000150:complications* / Q000382:microbiology; D002767:Cholecystostomy / Q000379:methods*; D004653:Empyema / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents