Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly

Background: The morbidity and mortality rates associated with acute cholecy stitis are higher in the elderly. This study reports the results of treatme nt of acute cholecystitis in the elderly with emergency ultrasonographicall y guided percutaneous cholecystostomy followed by elective cholecystectomy after endoscopic treatment of any common bile duct stones diagnosed by perc utaneous cholangiography. Methods: From January 1989 to December 1998, 92 patients aged over 70 years were treated for acute gallstone cholecystitis. A group of 84 patients wit h ultrasonographic signs of severe cholecystitis or an American Society of Anesthesiologists score of II to IV were submitted to ultrasonographically guided percutaneous cholecystostomy. Transcatheter cholangiography was perf ormed in all patients and endoscopic sphincterotomy was performed before op eration in patients with common bile duct stones. After resolution of the a cute phase and treatment of any associated diseases, patients were submitte d to cholecystectomy. Results: Cholecystostomy was performed successfully in 83 patients and perm itted resolution of the acute attack in all after a mean period of 1.8 days . Cholangiography yielded a diagnosis of non-gallstone obstruction in one p atient and common bile duct stones in 19 patients; preoperative endoscopic sphincterotomy and stone extraction was performed in 18 patients. Elective cholecystectomy was then performed in 70 patients with no deaths and a morb idity rate of 24 per cent. Conclusion: Combining emergency ultrasonographically guided percutaneous ch olecystostomy, preoperative endoscopic treatment of common bile duct stones and subsequent elective chole-cystectomy constitutes an optimal treatment regimen for acute gallstone cholecystitis in selected elderly patients with a mortality rate of zero in the authors' experience.