[Percutaneous gallbladder drainage a good treatment in patients with acute cholecystitis and and poor clinical status].

OBJECTIVE

To evaluate the results of ultrasound-guided percutaneous cholecystostomy in patients with increased surgical risk.

SETTING

University Hospital Rotterdam.

DESIGN

Retrospective.

MATERIAL AND METHOD

24 patients with acute cholecystitis and an increased surgical risk were treated with ultrasound-guided percutaneous cholecystostomy. Cholecystostomy was successfully performed in all patients.

RESULTS

23 patients showed clinical and biochemical improvement within one week. Minor complications were encountered in three cases (12%) which were treated conservatively. 16 patients suffered from calculous cholecystitis. One patient died after the cholecystostomy from an aspiration pneumonia. Cholecystectomy was performed at a later stage in six patients. One of these patients died six days after surgery from a myocardial infarction. Seven patients had percutaneous or endoscopic therapy for gallstones. In two cases no further therapy for gallstones was performed. Eight patients had acalculous cholecystitis. Four patients, suffering from cholangiocarcinoma and malignant obstruction of the cystic duct, subsequently underwent cholecystectomy (two patients) and percutaneous sclerotherapy of the gallbladder (two patients). Percutaneous cholecystostomy alone sufficed for the four remaining patients with acalculous cholecystitis.

CONCLUSION

Percutaneous cholecystostomy for high-risk patients with acute cholecystitis is a low-invasive procedure with low morbidity and mortality. The catheter in the gallbladder offers diagnostic and therapeutic possibilities and does not interfere with cholecystectomy at a later stage. In some cases of acalculous cholecystitis drainage of the gallbladder is the only therapy needed.