PERCUTANEOUS CHOLECYSTOSTOMY - A VALUABLE TECHNIQUE IN HIGH-RISK PATIENTS WITH PRESUMED ACUTE CHOLECYSTITIS

Percutaneous cholecystostomy offers a potentially important therapeuti c modality for critically ill patients with acute cholecystitis who re present a high risk for general anaesthesia. The aim of the study was to assess experience with percutaneous cholecystostomy in resolving th e acute episode of cholecystitis without operative intervention. Twent y-two consecutive patients with a clinical diagnosis of acute cholecys titis underwent the procedure. All were at high risk for general anaes thesia, and all but one developed cholecystitis while hospitalized for another co-morbid condition; 14 were in an intensive care unit. Twent y-one of the 22 patients proved to have acute cholecystitis (11 acalcu lous, ten cholelithiasis). There were no acute technical complications . Toxaemia resolved in 17 of the 21 patients with acute cholecystitis. Acute cholecystitis failed to resolve in three patients; all died wit hin 48 h from overwhelming generalized sepsis. One patient required em ergency cholecystectomy for bile peritonitis when the cholecystostomy catheter became dislodged 24 h after placement. The 60-day mortality r ate for the acalculous and calculous patient groups was 55 and 20 per cent, respectively. Only three interval cholecystectomies have been pe rformed at a mean follow-up of 19 months. In conclusion, percutaneous cholecystostomy may be the procedure of choice for the management of a cute cholecystitis in the very high-risk critically ill patient. If sy mptoms fail to resolve quickly, ongoing sepsis, cholangitis or gallbla dder necrosis should be suspected.