[Percutaneous cholecystostomy guided by ultrasonography. A preliminary experience]

Surgical cholecystostomy is a palliative treatment for cholecystitis and distal biliary obstructions when the general condition of the patient does not allow complex techniques. Percutaneous cholecystostomy (PC) guided by ultrasonography is an alternative to that procedure as well as a method of direct access to the biliary tract for diagnostic examinations (bacteriologic study of bile and percutaneous cholangiography). During one year, 9 female patients, mean age 74 (49 to 90) underwent this approach; 5 patients had cholecystitis, 2 were suspicious of biliary sepsis and 2 had angiocholitis. Because of poor general condition, no other approach was possible in any of the cases. There were no relevant complications. All 5 cases of cholecystitis improved after the procedure although 3 patients died within 30 days of causes unrelated to PC. In two cases biliary sepsis was ruled, and the probe was withdrawn, without complications. The two patients with angiocholitis improved significantly; in both cases it was shown that the cause was cholelithiasis: later on, they were treated by different methods (endoscopic sphincterotomy in one case and surgery in the third case). These preliminary results suggest that PC guided by echography should be included as a routine therapeutic and diagnostic method in the management of digestive diseases.