Percutaneous cholecystostomy in the management of acute cholecystitis.
BACKGROUND
The mainstay of therapy for acute cholecystitis is cholecystectomy, which has a mortality of 14-30% in high risk patients. An alternative approach in patients suffering from acute cholecystitis with contraindications to emergency surgery is percutaneous cholecystostomy.


OBJECTIVE
To evaluate the efficacy and safety of percutaneous cholecystostomy as the initial treatment of acute cholecystitis in high risk patients.


METHODS
Eighty consecutive patients (42 men, 38 women) underwent ultrasound-guided percutaneous cholecystostomy over a 5 year period. Sixty-five patients suffered from acute calculous cholecystitis, 4 patients had acalculous cholecystitis, and 11 patients had sepsis of unknown origin.


RESULTS
Sixty-eight patients improved after the percutaneous gallbladder drainage, 10 patients died from co-morbid disease and 2 patients died from biliary peritonitis. During a 1 year follow-up, 32 of the patients underwent interval cholecystectomy, 4 additional patients died from a co-morbid disease, 18 patients did not suffer from any gallbladder symptoms, and 14 were lost to follow-up.


CONCLUSIONS
Percutaneous cholecystostomy is an effective contribution to the treatment of acute cholecystitis in high risk patients.
Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.
Irith
I
Hadas-Halpern
Michael
M
Patlas
Michael
M
Knizhnik
Ibrahim
I
Zaghal
Drora
D
Fisher
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods; D002764:Cholecystitis / Q000401:mortality / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography