Percutaneous transhepatic cholecystostomy: effective treatment of acute cholecystitis in high risk patients.
BACKGROUND
The mortality rate for cholecystectomy for acute cholecystitis in the elderly is 10% in low risk patients and increases threefold in high risk patients. Ultrasound-guided percutaneous transhepatic cholecystostomy may serve as a rapid and relatively safe tool to relieve symptoms of sepsis and decrease gallbladder distension.


OBJECTIVE
To determine the safety and effectiveness of PTC in the treatment of acute cholecystitis in elderly debilitated high risk patients.


METHODS
The study sample included 10 patients aged 63-88 (mean 77.6 years) with clinical and sonographic signs of acute cholecystitis for more than 48 hours (fever, white blood cells > 12,000/mm, positive Murphy sign and distended gallbladder) who underwent ultrasound guided PTC. All had severe underlying disease (coronary heart disease, renal failure, chronic obstructive pulmonary disease, and others) that places them at high risk for surgical intervention.


RESULTS
Eight patients showed rapid regression of the clinical symptoms following PTC drainage. One patient with bacterial endocarditis was febrile for 5 days after catheter insertion, but with rapid resolution of the biliary colic and sepsis. One patient died from perforation of the gallbladder and small bowel. PTC catheters were withdrawn 3-25 days after the procedure and the patients remained free of biliary symptoms. Two patients underwent successful elective cholecystectomy 3 weeks later.


CONCLUSIONS
PTC may be a safe and effective treatment for high risk elderly patients with acute cholecystitis. It can be followed by elective cholecystectomy if the underlying condition improves, as soon as the patient stabilizes and no sepsis is present, or by conservative management in high surgical-risk patients.
Berman
Marius
M
Department of Surgery B, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel.
Nudelman
Israel L
IL
Fuko
Zeev
Z
Madhala
Osnat
O
Neuman-Levin
Margalit
M
Lelcuk
Shlomo
S
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography