title: Percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients.
  
  
  METHODS
  Six high-risk patients of choledocholithiasis complicated with moderate to severe acute cholangitis underwent percutaneous transhepatic cholecystostomy and subsequent interval open surgery from January, 2008 to October 2010. These patients, who were not suitable for both endoscopic and transhepatic biliary drainage, were reviewed retrospectively.
  
  
  RESULTS
  Percutaneous transhepatic cholecystostomy was performed uneventfully. One patient developed hemoperitoneum which was successfully controlled by conservative treatment. Biliary peritonitits occurred in two patients, one ceased to leak spontaneously, the other developed a biloma which was cured by repuncture. No procedure-related death occurred. Sepsis was relieved completely 3 to 4 days after procedure. Two patients underwent interval open exploration of the common bile duct. One patient who recovered from sepsis succumbed on day 12 post-cholecystostomy because of an acute cardiac infarct. The other 3 patients were cured of sepsis and discharged without further treatment.
  
  
  CONCLUSIONS
  The results showed that ultrasound-guided percutaneous transhepatic cholecystostomy is a safe and effective procedure for choledocholithiasis with moderate to severe acute cholangitis in highly selected high-risk surgical patients. It may deserve to become a definitive therapy for subsequent surgical management. Larger controlled studies are needed to further confirm our findings.
authors.affiliation: Department of General Surgery, Central South University, Changsha, China. zuhai123@yahoo.com.cn
authors.forename: Zuhai
authors.initials: Z
authors.lastname: Ren
authors.forename: Yong
authors.initials: Y
authors.lastname: Xu
authors.forename: Shaihong
authors.initials: S
authors.lastname: Zhu
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002767:Cholecystostomy / Q000009:adverse effects / Q000379:methods*; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional