We sought to determine the safety, efficacy, and outcome of percutaneous
cholecystostomy (PC) in all patients undergoing the procedure at our institutions. We reviewed 53 consecutive cases of
acute cholecystitis seen at our hospitals over 5.5 years in which PC was performed at the initial treatment. Follow-up was obtained by chart review and telephone questionnaire.
Acute cholecystitis was the primary admitting diagnosis in 18 cases. In the remaining 35,
cholecystitis developed during hospitalization. All patients were considered high surgical risks on the basis of the presence of comorbid conditions. The gallbladder was successfully catheterized under radiologic guidance in all patients and with no immediate procedure-related morbidity.
Acute cholecystitis resolved in 44 of 53 patients (83%), whereas nine patients (17%) did not improve clinically after PC and died during the same hospitalization. A total of 33 (62%) eventually survived hospitalization. Elective
cholecystectomy was done in 25 patients with no mortality. After
cholecystectomy, three of these patients subsequently died of other causes, whereas 22 are alive. Eight patients did not undergo
cholecystectomy because of underlying medical conditions or because they had
acalculous cholecystitis. These patients remained free of biliary problems after removal of their
cholecystostomy tube, but two have subsequently died of nonbiliary conditions. Percutaneous
cholecystostomy is a safe, effective treatment for high-risk patients with
acute cholecystitis.
Cholecystostomy can be followed by elective
cholecystectomy at a later time if the patient's condition permits or by expectant
conservative management in patients who have had
acalculous cholecystitis or have a very high mortality risk with surgery.