title: Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention.
abstract: OBJECTIVE
  To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia.
  
  
  METHODS
  The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases.
  
  
  RESULTS
  Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 13 x 10(3)+/-1 x 10(3) microg/L, P < 0.05 for 24 h after PC; 13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 8.3 x 10(3)+/-1.2 x 10(3) microg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2+/-18.5 mg/L vs 27.3+/-10.4 mg/L, P < 0.05 for 24 h after PC; 51.2+/-18.5 mg/L vs 5.4+/-1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38+/-0.35 centigrade vs 37.3+/-0.32 centigrade, P < 0.05 for 24 h after PC; 38+/-0.35 centigrade vs 36.9+/-0.15 centigrade, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter.
  
  
  CONCLUSIONS
  As an alternative to surgery, percutaneous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality and morbidity. Delayed cholecystectomy and ERCP, if needed, can be performed after the acute period has been resolved by percutaneous cholecystostomy.
authors.affiliation: Trauma and Emergency Surgery Service, Istanbul University, Istanbul Faculty of Medicine, Capa-Istanbul 34390, Turkey. drhuseyin@yahoo.com
authors.forename: Huseyin
authors.initials: H
authors.lastname: Bakkaloglu
authors.forename: Hakan
authors.initials: H
authors.lastname: Yanar
authors.forename: Recep
authors.initials: R
authors.lastname: Guloglu
authors.forename: Korhan
authors.initials: K
authors.lastname: Taviloglu
authors.forename: Fatih
authors.initials: F
authors.lastname: Tunca
authors.forename: Murat
authors.initials: M
authors.lastname: Aksoy
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Ertekin
authors.forename: Arzu
authors.initials: A
authors.lastname: Poyanli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography