Percutaneous cholecystostomy in critically ill patients.

Area of Science:

• Medical Procedures
• Gastroenterology
• Critical Care Medicine

Background:

• Acute cholecystitis is a common condition requiring intervention.
• Critically ill patients present unique challenges for surgical and interventional procedures.
• Percutaneous cholecystostomy is an alternative to surgery for acute cholecystitis.

Purpose of the Study:

• To reassess the value and success rate of percutaneous cholecystostomy.
• To evaluate the outcomes of percutaneous cholecystostomy in critically ill patients.
• To identify factors influencing the success of this procedure in a high-risk population.

Main Methods:

• Retrospective review of sixteen critically ill patients undergoing percutaneous cholecystostomy for suspected acute cholecystitis.
• Analysis of procedural success, patient outcomes, and subsequent interventions.
• Correlation of imaging findings (CT/ultrasound) with clinical outcomes.

Main Results:

• The procedure was technically successful in all sixteen patients.
• Eleven patients (69%) died due to underlying conditions, irrespective of the intervention.
• Four of eleven patients with definite acute cholecystitis were cured; three required surgery for gallbladder wall necrosis.
• Two of these surgical cases had pericholecystic fluid on imaging.
• Five patients with undetermined acute cholecystitis showed no improvement after the procedure.

Conclusions:

• Percutaneous cholecystostomy has a lower success rate in critically ill patients compared to previous reports.
• The presence of pericholecystic fluid may indicate a need for surgery.
• High mortality in this group is primarily due to severe underlying diseases.