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[Percutaneous cholecystostomy and papilloplasty in elderly high-risk patient. Case report]
Francesco Milone1, Marco Milone, Marcello Bellini
1Dipartimento di Chirurgia, Ortopedia, Microchirurgia e Riabilitazione - Area Funzionale di Chirurgia Generale, Università degli Studi di Napoli "Federico II" Italia.
Insights
Percutaneous cholecystostomy offers a safe, temporary solution for high-risk acute cholecystitis patients with gallstones. This minimally invasive procedure can prevent recurrence and manage biliary disease effectively, especially in elderly or critically ill individuals.
Area of Science:
- Gastroenterology and Hepatology
- Interventional Radiology
Background:
- Acute cholecystitis, often caused by gallstones, presents a management challenge in high-risk surgical patients.
- Laparoscopic cholecystectomy is the standard treatment but may be contraindicated in elderly or critically ill patients.
Observation:
- Percutaneous cholecystostomy was evaluated as a temporary management strategy for acute cholecystitis in high-risk patients.
- The study assessed the feasibility and effectiveness of this minimally invasive approach, including its role in preventing recurrence and managing concomitant biliary disease.
Findings:
- Percutaneous cholecystostomy is a safe and effective temporary treatment for acute cholecystitis in surgical high-risk patients.
- The procedure facilitates physiologic biliary drainage, preventing gallstone recurrence.
- Concomitant percutaneous treatment of biliary disease is also feasible.
Implications:
- Percutaneous cholecystostomy provides a viable alternative for managing acute cholecystitis in patients unsuitable for surgery.
- This approach can improve outcomes and prevent recurrence in a challenging patient population.
- It highlights the potential for less invasive interventions in complex hepatobiliary conditions.
Abstract:
When acute cholecystitis is suspected in a very high-risk patient, percutaneous cholecystostomy should be considered as a safe and effective temporary management of patients with gallstones. Whenever possible, percutaneous cholecystostomy should be followed by laparoscopic cholecystectomy. In elderly patients who are inappropriate surgical candidates because of severe concomitant systemic diseases, less invasive treatments may prevent recurrence. Our experience shows the feasibility of percutaneous cholecystostomy to achieve an effective treatment of acute cholecystitis in surgical high-risk patients with a physiologic biliary drainage of gallstones in duodenum to prevent recurrence. Moreover we demonstrated the feasibility of a concomitant percutaneous treatment of biliary disease.
