GALLBLADDER PUNCTURE AND CHOLECYSTOSTOMY AS A THERAPY FOR ACUTE CHOLECYSTITIS

Patients and Methods: An ultrasound-guided, percutaneous puncture (n = 30) and cholecystostomy (n = 10) was performed on 40 high-risk patien ts aged between 38 and 99 (mean age 78 years old) suffering from acute lithogenic cholecystitis or acalculous stress cholecystitis on accoun t of general inoperability. Two catheter dislocations and in 3 cases a slight bile leakage were observed as complications. Results: The punc ture and drainage led to a dramatic alleviation of pain for all patien ts, the involution of a paralytic subileus and improvement of the gene ral condition. Eighteen patients underwent a laparoscopic or open inte rval cholecystectomy in a stabilised condition. There was no recurrenc e of inflammation in 22 patients over a follow-up period of up to 5 ye ars, so that one can assume a cicatrised healing of the acute choleycs titis. Conclusions: Ultrasound-guided, percutaneous puncture and chole cystostomy are effective, low-risk, and only slightly invasive procedu res which can be employed for risk patients with acute cholecystitis a s a life-saving, and in some cases definitive treatment. On account of pathogenic considerations, they should be included in the diagnostic and therapeutic concept at an early stage, particularly for acute, aca lculous stress cholecystitis.