ULTRASOUND-GUIDED PERCUTANEOUS CHOLECYSTOSTOMY AS AN INITIAL TREATMENT FOR ACUTE CHOLECYSTITIS IN ELDERLY PATIENTS

Background/Aims: Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems, and it is well recognized as a high-risk condition for morbidity. The outcome has been attributed to the presence of servere co-morbid disease. In an attempt to minimize the postoperative morbidity and mortality, we p erformed ultrasound-guided percutaneous transhepatic cholecystostomy ( PC) on elderly patients with acute cholecystitis for both initial trea tment and subsequent diagnosis of their biliary tract disorders. Metho ds: Those being more than 70 years old, had acute episode of cholecyst itis for more than 48 h and still had positive Murphy's signs and dist ended gallbladders were candidates for ultrasound-guided PC. Results: Forty-two elderly patients underwent ultrasound-guided PC. Once the co ndition of each patient showed signs of improvement and stability, cho langiography was performed via PC tube. The results of the cholangiogr aphy showed 20 patients with gallbladder stones, 16 with common bile d uct stones and 6 with acalculous cholecystitis. Once stable enough, 32 patients underwent definite surgery, 18 having cholecystectomies, 14 having cholecystectomies and choledocholithotomies. The 6 patients wit h acalculous cholecystitis had the PC tube removed 3 weeks later, with out further surgery. Two patients had gallbladder stones removed by ch oledochofiberscope. Two patients had common bile duct stone removed by endoscopic sphincteroplasty. Although postoperative complications occ urred in 5 patients (11.9%), no instance of operative mortality was fo und. Conclusion: Our findings lead us to conclude that the use of PC i n the early treatment of acute cholecystitis in elderly patients can d ecrease postoperative morbidity and mortality.