Delayed gallbladder rupture following percutaneous cholecystostomy

Percutaneous cholecystostomy has become an accepted therapeutic alternative for high-risk patients with acute cholecystitis. However, some authors have cautioned that patients with gallbladder wall necrosis and gangrene may not be effectively treated by means of percutaneous drainage alone. A case is reported in which gallbladder wall necrosis progressed following technically successful percutaneous drainage. Spontaneous gallbladder rupture ensued, necessitating emergent cholecystectomy. Cholecystography 2 weeks following tube placement and 1 week prior to rupture showed a markedly abnormal, irregular gallbladder lumen. The authors suggest that follow-up cholecystography may be a useful tool for evaluating patient response to percutaneous cholecystostomy and for determining subsequent patient management.