title: Safety and effectiveness of percutaneous cholecystostomy in critically ill children who are immune compromised.
abstract: BACKGROUND
  Acalculous cholecystitis is known to develop in critically ill patients without cystic duct obstruction. In the past, treatment for acalculous cholecystitis has been cholecystectomy; however, many children who are critically ill are Percutaneous cholecystostomy is likely the procedure of choice in this subgroup of patients.
  
  
  OBJECTIVE
  To assess the safety and effectiveness of percutaneous cholecystostomy in critically ill and immune-compromised children with acalculous cholecystitis.
  
  
  METHODS
  Retrospective review of immune-compromised and critically ill children who underwent percutaneous cholecystostomy between 2006 and 2013. Diagnostic imaging performed included ultrasound, CT and hepatobiliary scintigraphy. Every percutaneous cholecystostomy was performed using imaging guidance.
  
  
  RESULTS
  Ten critically ill and immune-compromised children with acalculous cholecystitis underwent percutaneous cholecystostomy. Seven boys and 3 girls, ranging in age from 10 months to 15 years 8 months, were treated. Six of the immune-compromised children had received a bone marrow transplant for leukemia (5 children) or severe combined immunodeficiency (SCID) (1 child), and ranged from 18 to 307 days post bone marrow transplant at the time of their percutaneous cholecystostomy. Of the remaining four immune-compromised children with acalculous cholecystitis who underwent percutaneous cholecystostomy, two had leukemia, one had SCID and lymphoma, and the fourth was undergoing treatment for undifferentiated germ cell tumor. The 10 percutaneous gallbladder drains were placed using a transhepatic approach, except one unintentional transperitoneal approach. There were no complications. Three gallbladder drains were removed in Interventional Radiology. Those three patients had a return to normal gallbladder function and didn't require cholecystectomy. Two drains were removed during cholecystectomy and another as an outpatient. Four patients died in the hospital due to multiorgan system failure, with indwelling gallbladder drains.
  
  
  CONCLUSIONS
  Percutaneous cholecystostomy is a safe procedure in immune-compromised and critically ill children with acalculous cholecystitis. Percutaneous cholecystostomy may obviate the need for future cholecystectomy.
authors.affiliation: Department of Medical Imaging, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA. cschaefer@phoenixchildrens.com.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Schaefer
authors.affiliation: Department of Medical Imaging, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Towbin
authors.affiliation: Department of Medical Imaging, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Aria
authors.affiliation: Department of Medical Imaging, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
authors.forename: Robin D
authors.initials: RD
authors.lastname: Kaye
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000601:surgery*; D002767:Cholecystostomy / Q000379:methods*; D016638:Critical Illness; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acalculous cholecystitis; Children; Gallbaldder; Interventional radiology; Percutaneous cholecystostomy