PERCUTANEOUS CHOLECYSTOSTOMY FOR THE DIAGNOSIS AND TREATMENT OF ACUTECALCULOUS AND ACALCULOUS CHOLECYSTITIS

PURPOSE: To determine the safety, efficacy, and diagnostic utility of percutaneous cholecystostomy in patients with suspected calculous or a calculous cholecystitis, PATIENTS AND METHODS: Percutaneous cholecysto stomy guided with ultrasound (US) was performed in 58 consecutive hosp italized patients with suspected acute cholecystitis (28 with calculou s, 30 with acalculous disease) who were not surgical candidates, RESUL TS: The gallbladder was successfully catheterized in all 58 patients; 48 patients (83%) had a final diagnosis of acute cholecystitis, Clinic al benefit was seen in 26 of 28 patients (93%) with calculous cholecys titis and in 16 of 20 patients (80%) with acalculous disease, The six patients who did not respond had pathologic evidence of transmural inf lammation, and five had a gangrenous wall, The gallbladder was exclude d as the source of sepsis in 10 patients with suspected acalculous cho lecystitis. These patients' conditions did not improve after percutane ous cholecystostomy, Of the 48 patients with cholecystitis, 18 underwe nt cholecystectomy, 25 recovered and had their catheters removed, and five died of other causes with their catheters in place, There was one major complication, and seven minor complications, CONCLUSION: Percut aneous cholecystostomy is efficacious in both calculous and acalculous cholecystitis, but it may be most useful in the diagnosis of acalculo us cholecystitis.