title: Percutaneous transhepatic cholecystoduodenal stent for empyema of the gallbladder.
abstract: Acute cholecystitis is treated by antibiotics and cholecystectomy. When the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct, an empyema of the gallbladder develops. Under these circumstances, treatment may be either cholecystectomy or, in the presence of significant comorbidity, by drainage via percutaneous cholecystostomy, followed at a later date by cholecystectomy. We present the case of a patient who presented acutely with an attack of cholecystitis and refused to undergo a cholecystectomy owing to previous respiratory arrest following general anaesthesia. She settled with intravenous antibiotic treatment and was discharged. However, she presented shortly afterwards with a further attack of cholecystitis that was refractory to intravenous antibiotics and so was treated initially with percutaneous drainage. This was subsequently replaced with interno-external drainage of the gallbladder (transpapillary cholecystoduodenal stent) with the use of a J-J ureteric stent, which was then fully internalised. She remained well following this procedure and was discharged home. The long-term patency of the stent is not known and we hope that no further intervention will be required, but if necessary the stent could be exchanged endoscopically, by a percutaneous route, or via a combined approach.
authors.affiliation: Departments of Hepatopancreaticobiliary Surgery, Imperial College of Science and Technology, London W12 0HS, UK. piers.gatenby@btinternet.com
authors.forename: P
authors.initials: P
authors.lastname: Gatenby
authors.forename: M
authors.initials: M
authors.lastname: Flook
authors.forename: D
authors.initials: D
authors.lastname: Spalding
authors.forename: P
authors.initials: P
authors.lastname: Tait
mesh_terms: D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods; D004322:Drainage / Q000379:methods; D004653:Empyema / Q000601:surgery*; D005260:Female; D006801:Humans; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D016312:Treatment Refusal