[Contact litholysis of gallstones with methyl tert-butyl ether in risk patients--a case report].
BACKGROUND
Before laparoscopic cholecystectomy and endoscopic therapy became gold standard the nonsurgical treatment of symptomatic cholelithiasis, i.e. contact dissolution using methyl-tert-butyl ether (MTBE), was a valuable alternative. Even nowadays, stone dissolution may be helpful in critically ill patients.


METHODS
A 85-year-old man admitted in poor general condition due to cholangitis with septicemia following endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and partial stone removement because of impending perforation of the gallbladder empyema was treated by a percutaneous cholecystostomy with a pigtail catheter. After clinical improvement a successful contact dissolution was initiated by irrigation of the common bile duct and gallbladder with MTBE. The patient is asymptomatic three months after treatment.


CONCLUSIONS
Symptomatic cholelithiasis is usually treated by endoscopic techniques. Percutaneous cholecystostomy in association with contact litholysis using MTBE is an effective treatment in patients who can not be operated due to critical conditions. The success rate in case of cholesterol stones averages 70 to 95% depending on number and size of stones. It is a non-invasive treatment with few side effects.


CONCLUSIONS
In high-risk patients with severe cholecystitis, percutaneous catheter cholecystostomy combined with contact litholysis using MTBE is a successful, safe, and cheap treatment.
Abteilung Chirurgie Spital Oberengadin, Samedan. fhetzer@dplanet.ch
F H
FH
Hetzer
M
M
Baumann
H P
HP
Simmen
D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000601:surgery; D002767:Cholecystostomy; D002769:Cholelithiasis / Q000601:surgery*; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D016717:Sphincterotomy, Endoscopic; D007507:Therapeutic Irrigation
D008738:Methyl Ethers; C043243:methyl tert-butyl ether