Imaging of the percutaneous cholecystostomy tract: observations and utility

The technique and observations in 28 patients who underwent imaging of the percutaneous cholecystostomy (PC) tract are described. Imaging of the tracts was performed by injecting contrast material through an end-hole dilator during catheter removal (n = 13) or through an end-hole dilator with a side adapter over a thin guide wire (n = 15); the latter method permitted simple catheter reinsertion if the tract was poorly formed. Catheters were removed between 9 and 158 days (mean, 36.6 days; median, 29.5 days) after PC. Twenty-three patients had well-formed tracts and five patients did not. Among the five patients with a poorly formed tract, two experienced no sequela as a result of catheter withdrawal, two underwent immediate catheter reinsertion, and one developed bile peritonitis; this last patient was treated with repeated PC and antibiotics. All patients in whom a catheter was placed for at least 20 days had a well-formed, intact tract. Imaging of the PC tract is helpful to identify patients who have an immature tract. In a patient with a poorly formed tract, catheter reinsertion may be advisable to prevent bile leakage and peritonitis.