IS PERCUTANEOUS CHOLECYSTOSTOMY THE OPTIMAL TREATMENT FOR ACUTE CHOLECYSTITIS IN THE VERY ELDERLY

In elderly patients emergent cholecystectomy for acute cholecystitis i s a high risk procedure. We prospectively assessed the value of percut aneous cholecystostomy for acute cholecystitis in 38 consecutive elder ly (greater than or equal to 80 years) patients, All 38 underwent perc utaneous transhepatic cholecystostomy under ultrasonographic and fluor oscopic guidance for acute cholecystitis (25 calculous, 13 acalculous) . Eight (21%) patients had acute severe medical problems, such as shoc k and respiratory distress. Thirty-one (82%) patients had chronic seve re underlying diseases, including cardiovascular and neurologic diseas es, Cholecystostomy was successful in all 38 patients, Prompt clinical improvement was obtained in 36 (95%) patients, Morbidity and mortalit y rates were 3% and 3%, respectively, After cholecystostomy, 10 patien ts with cholelithiasis underwent elective cholecystectomy without seri ous complications. Two patients underwent percutaneous cholecystolitho tomy, which produced complete resolution of symptoms. Four of 12 patie nts with and none of 12 without cholelithiasis had recurrent cholecyst itis after catheter removal during a mean follow-up of 1.8 years. A se cond cholecystostomy was successful in these four patients. Elderly pa tients are often poor surgical candidates because of severe cholecysti tis or concomitant medical problems, Percutaneous cholecystostomy is a safe, effective treatment for acute cholecystitis even in elderly pat ients, For calculous cholecystitis, cholecystostomy can be followed by elective surgery, if possible, or by nonsurgical treatment or expecta nt conservative management in high-risk patients, Cholecystostomy may be a definitive treatment for acalculous cholecystitis.