[Echo-guided percutaneous cholecystostomy in the treatment of acute cholecystitis]

Ultrasound-guided cholecystostomy (UGC) is indicated for high-risk patients with acute cholecystitis (AC). The advantage of this approach is greatest for critically ill patients who develop AC while in the intensive care unit (ICU). Moreover, in ICU patients with unexplained sepsis UGC serves as a diagnostic maneuver since it may allow the identification of a biliary infection. UGC has a high therapeutic efficacy approaching 100% in patients with a well-established diagnosis of AC. Morbidity is low and almost entirely related to catheter dislodgment. Trans-catheter cholecystocholangiograms (TCC), indispensable for planning any further treatment, must be delayed until the resolution of the sepsis. The risk of recurrence depends on AC etiology. Acalculous AC entails a low recurrence risk and may often be managed non-operatively. After the resolution of the sepsis, all calculous AC should be considered for cholecystectomy. However, if the operative risk remains high the possibility of avoiding the operation depends on the TCC demonstration of the patency of the cystic duct. The catheter should remain in place until operation. In case of non-operative management withdrawal should be delayed until the resolution of the sepsis. Laparoscopy is suitable in case of recent inflammation.