Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk.
OBJECTIVE
To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk.


METHODS
Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy.


RESULTS
All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor-moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 3). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related.


CONCLUSIONS
Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.
van Overhagen
H
H
Department of Radiology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Meyers
H
H
Tilanus
H W
HW
Jeekel
J
J
Laméris
J S
JS
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D002758:Cholangiography / Q000295:instrumentation; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000628:therapy*; D002767:Cholecystostomy / Q000295:instrumentation*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome