Laparoscopic cholecystostomy is a safe and effective alternative in critically ill patients with acute cholecystitis: two cases.
Emergency cholecystectomy for acute cholecystitis in critically ill patients with organ failure and sepsis carries a high risk of morbidity and mortality. Temporizing interventions such as laparoscopic cholecystostomy can help the patient to recover from the critical illness by deferring the definitive procedure to a later, safer period. We describe our experience of laparoscopic cholecystostomy performed in two critically ill patients. In the first case, a 56-year-old man with hypertension, diabetes, and ischemic heart disease, was admitted for evaluation of malena. During the course of his stay, he developed acute calculous cholecystitis, acute renal failure, and right pleural effusion. In the second case, a 68-year-old man presented with diabetes, hypertension, diabetic nephropathy, acute chronic renal failure, and acute calculous cholecystitis. Both patients failed to improve with conservative measures and underwent laparoscopic cholecystostomy under local anesthesia and sedation in view of severe comorbidities and sepsis. Both patients recovered from sepsis. Laparoscopic cholecystectomy was performed uneventfully after six and eight weeks, respectively, and both patients were doing well at one-year follow-up.
Chowbey
Pradeep K
PK
Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India. chowbey1@vsnl.com
Venkatasubramanian
R
R
Bagchi
Nabanita
N
Sharma
Anil
A
Khullar
Rajesh
R
Soni
Vandana
V
Baijal
Manish
M
D000208:Acute Disease; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000150:complications / Q000601:surgery*; D016638:Critical Illness; D006801:Humans; D008297:Male; D008875:Middle Aged