Percutaneous Cholecystostomy (PC) was attempted in 78 consecutive patients and 42 patients were followed since Dec. 1990. PC was successful in 12 cases of acalculous acute choleystitis (AC), but 2 patients has a recurrent episode of cholecystitis
during
follow-up period.
In 16 cases (38%) PC was the only treatment performed (12 acalculous AC, 2 pericholecystic abscess and two calculous AC); in 2 cases ( caloulous AC) PC was combined with lithotripsy, the stone fragments being extracted via the dilated
cholecystostomy.
There were 28 cases of calculous AC; 23 cases underwent cholecystectomy following PC by means of laparoscopic (11 cases), conventional (10 cases) and mini-lap (2 cases) procedure.
The mean drainage time was 20.3 days (9 cases) in acalculous AC and 44.0 days (21 cases) in calculous AC. There were 3 cases of mortality; vago-vagal reflex (1 cases) and refractory shock (2 cases were the cause.
Patients were considered for PC if they were older than 65 years (15 cases), refusing surgery (9 cases), in septic shock requiring vasopressor (7 cases) and recovering from recent operation (3 cases). Also indications for PC iuncluded previous
operation
scar (3 cases), advenced pulmonary tuberculosis (2 cases), vocal cord stricture (1 case) and patients in impending perforation (2 cases) for immediate relief of symptoms.
Early cholecystectomy under the a antibiotic prophylaxis is the treatment of choice, but PC can be successfully performed under the ultrasound guidance and has a place in the treatment of severely ill and difficult patients. Also PC can provides
wide
variety of therapeutic options including novel methods.
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