title: Percutaneous cholecystostomy for acute cholecystitis: ten-year experience.
abstract: OBJECTIVE
  To review the clinical course of patients with acute cholecystitis treated by percutaneous cholecystostomy, and to identify risk factors retrospectively that predict outcome.
  
  
  METHODS
  A total of 106 patients diagnosed with acute cholecystitis were treated by percutaneous cholecystostomy during a 10-year period. Seventy-one (67%) presented to the emergency department (ED) specifically for acute cholecystitis, and 35 (23%) were inpatients previously admitted for other conditions. Outcomes of the two groups were compared with respect to severity of illness, leukocytosis, bile culture, liver function tests, imaging features, time intervals from onset of symptoms to medical and percutaneous intervention, and whether surgical cholecystectomy was later performed.
  
  
  RESULTS
  Overall, 72 patients (68%) showed an improvement clinically, whereas 34 (32%) showed no improvement or a clinically worsened condition after cholecystostomy. Patients who presented to the ED primarily with acute cholecystitis fared better (84% of patients showed improvement) than inpatients (34% showed improvement; P < .0001). Gallstones were identified in 54% of patients who presented to the ED, whereas acalculous cholecystitis was more commonly diagnosed in inpatients (54%). Patients with sepsis had worse outcomes overall (P < .0001). Bacterial bile cultures were analyzed in 95% of patients and showed positive results in 52%, with no overall effect on outcome. There was no correlation between the time of onset of symptoms until antibiotic therapy or cholecystostomy in either group. Long-term outcomes for both groups were better for those who later underwent cholecystectomy (P < .0001).
  
  
  CONCLUSIONS
  Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness.
authors: Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA 94305, USA.
authors: Tim
authors: T
authors: Joseph
authors: Kamil
authors: K
authors: Unver
authors: Gloria L
authors: GL
authors: Hwang
authors: Jarrett
authors: J
authors: Rosenberg
authors: Daniel Y
authors: DY
authors: Sze
authors: Syed
authors: S
authors: Hashimi
authors: Nishita
authors: N
authors: Kothary
authors: John D
authors: JD
authors: Louie
authors: William T
authors: WT
authors: Kuo
authors: Lawrence V
authors: LV
authors: Hofmann
authors: David M
authors: DM
authors: Hovsepian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041881:Cholecystitis, Acute / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007964:Leukocytosis; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome