Percutaneous cholecystostomy in critically ill patients with a cholecystitis: a safe option.
BACKGROUND
Cholecystectomy is the standard procedure in patients with acute cholecystitis. However, some patients might not be able to undergo immediate surgery because of severe sepsis or underlying comorbid conditions. Percutaneous cholecystostomy is a minimally invasive radiological procedure under local anesthesia which seems to be an effective alternative to conservative treatment or immediate laparoscopic/open cholecystectomy.


METHODS
We retrospectively analyzed 35 patients who underwent percutaneous cholecystostomy between 2003 and 2009.


RESULTS
Percutaneous cholecystostomy was technically successful in all patients. Symptoms resolved within 3 days in 33/35 patients. Two patients needed an emergency laparotomy. The catheter dislodged in 5 patients and was replaced in 2/5. The 30-day mortality rate was 3/35 (8.7%) due to gallbladder necrosis, myocardial infarction and multiorgan failure. Median length of hospital stay was 17 days and median drainage time was 28 days. 23 patients (66%) underwent open or laparoscopic cholecystectomy after a median interval of 44 days.


CONCLUSIONS
Percutaneous cholecystostomy is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or underlying comorbid conditions, preferably followed by interval cholecystectomy to prevent recurrent cholecystitis.
Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. boukjekoebrugge@hotmail.com
B
B
Koebrugge
M
M
van Leuken
M F
MF
Ernst
I
I
van Munster
K
K
Bosscha
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D015897:Comorbidity; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis; D013997:Time Factors