Percutaneous cholecystostomy for suspected acute cholecystitis in the hospitalized patient.

PURPOSE: The authors evaluated the outcome of 49 hospitalized patients with sepsis and possible acute cholecystitis in whom emergency percutaneous cholecystostomy was attempted on 50 occasions.

PATIENTS AND

METHODS

All cholecystostomy procedures were performed with ultrasound (US) guidance by using either the trocar (n = 35) or the Seldinger (n = 15) technique. Forty of the 50 cholecystostomies (80%) were attempted at the patients' bedside, and 49 of the 50 catheters (98%) were placed successfully.

RESULTS

Twenty-five of these patients eventually died of other causes (51%), but there was clinical improvement in 31 of the 49 patients (63%) based on a 72-hour decrease of temperature to less than 37.3 degrees C, normalization of white blood cell count, and/or resolution of abdominal pain. US findings were correlated with clinical response. Clinical improvement occurred most frequently after cholecystostomy in patients with either a distended gallbladder (74%), pericholecystic fluid (80%), or gallstones (92%). Forty-three of the 49 patients underwent cholecystostomy alone (88%), and six required further procedures (12%). There were six complications (12%) including catheter dislodgment (n = 3), hematoma (n = 1), and severe pain (n = 2). No deaths were directly attributed to percutaneous cholecystostomy.

CONCLUSION

Percutaneous cholecystostomy performed in septic hospitalized patients is a low-risk procedure that may be helpful in the treatment of some patients with suspected acute cholecystitis.