Ultrasound-guided percutaneous cholecystostomy in high-risk surgical patients

Background and aims: In critically ill patients. cholecystectomy is associa ted with a high mortality fate. The aim of this study was to evaluate the s afety, efficacy and lone-term outcome of ultrasound-guided percutaneous cho lecystostomy (USGPC) in critically ill patients with acute cholecystitis. M aterials and methods: Clinical records of 51 patients, all considered high- risk surgical patients. with acute cholecystitis treated with USGPC between 1987 and 1999, were retrospectively reviewed. Response was defined as impr ovement in clinical symptoms and signs. and/or reduction in c-reactive prot ein and white blood count levels within 72 h. Long-term results were evalua ted by means of clinical records and written correspondence. Results: Gallb ladder stones were seen in 28 patients whereas 23 had acalculous cholecysti tis. Ninety percent showed clinical improvement after USGPC. Cholecystectom y was performed in 16% of which 6% after recurrent cholecystitis. Recurrenc e of cholecystitis occurred in 22%. Hospital mortality was 16%. None of the deaths was procedure related or related to acute cholecystitis alone. Majo r complications relating to the USGPC were ran (4%), while minor catheter-r elated complications were quite common. Conclusions: USGPC is a procedure w ith few complications and a high success rate. In patients with acalculous cholecystitis as well as in many patients with calculous cholecystitis, no further treatment was needed.