Percutaneous cholecystostomy in acute cholecystitis in high-risk patients:An analysis of 69 patients

Background: Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues to be a difficult therapeutic problem, W ith the development of more advanced radiological imaging techniques, percu taneous cholecystostomy (PCS) has been presented as an effective treatment alternative in critically ill patients. This paper reports our experiences of percutaneous cholecystostomy in the treatment of acute cholecystitis in a well defined highrisk patient group. Methods: The data concerning 69 high-risk patients with acute cholecystitis treated by percutaneous cholecystostomy in Oulu University Hospital and Ko kkola Central Hospital were analyzed, Results: Ultrasound showed gallbladder stones in 71% (49/69) of the patient s and 29% of them presented with acalculous cholecystitis. After PCS, pain diminished in 94% (61/65), fever in 90% (35/39), CRP values in 87 % (53/61) and leucocyte count in 84% (46/55) of the patients, Before PCS, the CRP va lue was 132 +/- 106 mg/l and after PCS 79 +/- 73 mg/l (P = 0.001) and corre sponding leucocyte counts were 14.7 +/- 5.0 and 9.3 +/- 3.2 (P = 0.001), re spectively. The antegrade cholecystocholangiography was performed in 29 pat ients after PCS, and common bile duct stones were detected in 8 patients; t hese stones were treated by endoscopic papillotomy, Complications after PCS occurred in 17 patients (26%), but only two patients required emergency la parotomy, Mortality was 19% (13/69), Acute cholecystitis alone was the caus e of death in only three patients. Mostly, fatal outcome was caused by the serious underlying diseases. Conclusion: According to our results, PCS should be the method of choice in high-risk patients with acute cholecystitis.