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Percutaneous cholecystostomy (PC) in the management of acute cholecystitis in high risk patients

Shaista Afzal Saeed1, Imrana Masroor

  • 1Department of Radiology, The Aga Khan University Hospital, Stadium Road, Karachi. shaista.afzal@aku.edu

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|September 3, 2010
PubMed

Insights

Ultrasound-guided percutaneous cholecystostomy (PC) is a safe and effective treatment for acute cholecystitis in high-risk patients. This procedure offers a favorable clinical response and low complication rates, providing an alternative to immediate surgery.

Area of Science:

  • Gastroenterology
  • Interventional Radiology
  • Surgical Oncology

Background:

  • Acute cholecystitis management in high-risk patients presents challenges.
  • Conservative management may fail in select cases.
  • Percutaneous cholecystostomy (PC) is an alternative for non-resolving acute cholecystitis.

Purpose of the Study:

  • To evaluate the role of ultrasound-guided PC in managing acute cholecystitis.
  • To assess complications and outcomes in high-risk surgical patients.
  • To determine PC's efficacy in cases unresponsive to conservative treatment.

Main Methods:

  • Observational case series conducted at The Aga Khan University Hospital from 2003-2007.
  • Included patients with acute cholecystitis unfit for immediate surgery and unresponsive to conservative management.
  • Ultrasound-guided PC was performed; variables included demographics, comorbidities, ultrasound findings, procedure details, complications, and clinical outcomes (48 hours and 30 days).

Main Results:

  • Forty-one patients (15 males, 26 females; mean age 65 years) were studied.
  • Indications included calculus cholecystitis (25), acalculous cholecystitis (10), empyema (4), and gallbladder perforation (2).
  • No procedure-related complications occurred in 75% of patients; 83% showed favorable clinical response. Mortality was 12% due to underlying conditions, with no direct procedure-related deaths.

Conclusions:

  • Ultrasound-guided PC is a safe and effective procedure for immediate management of acute cholecystitis in high-risk patients.
  • It offers a viable alternative for patients not responding to conservative treatment and unfit for surgery.
  • The procedure demonstrates a low complication rate and positive clinical outcomes.
Abstract

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