Radiographic aspects in transcatheter contact dissolution of calcified gallbladder concrements

The present study on 10 patients reports upon an attempt to perform percutaneous contact dissolution of partially calcified gallbladder concrements. These gallstones, which exhibited structural calcifications on CT scans, required time-consuming complex dissolution procedures with transcatheter administration of methyl tert-butyl ether (MTBE) and ethylene diamine tetraacetic acid (EDTA). Insertion of the catheter system (5 F) was performed via a percutaneous transhepatic route. Catheter placement was maintained for a maximum of 4 days. Complete lysis was achieved in seven of the ten cases. In six patients, significant regional or disseminated chemically induced cholecystitis and pericholecystitis could be observed on CT examination. However, on follow-up CT examinations, these changes proved to be completely reversible. It has been demonstrated that tolerance of the gallbladder wall and adjacent tissue layer against the lytic media employed is rather limited and that meticulous controlling of the morphological reaction can be helpful in minimizing complications.