Perforated emphysematous cholecystitis managed by endoscopic transpapillary gallbladder drainage

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Perforated emphysematous cholecystitis presents a high surgical risk, especially in elderly patients with comorbidities.
• Gallbladder drainage is crucial for managing localized peritonitis associated with this condition.

Observation:

• An 88-year-old woman with dementia and perforated emphysematous cholecystitis underwent endoscopic transpapillary gallbladder drainage due to high surgical risk.
• A nasobiliary drainage tube was initially placed, followed by a double-pigtail stent to manage the perforated gallbladder and prevent bile leakage.

Findings:

• The endoscopic transpapillary approach successfully drained and cleaned the perforated gallbladder.
• The patient showed clinical improvement and was managed conservatively without immediate surgery.
• Follow-up for 6 months revealed no recurrence of cholecystitis.

Implications:

• Endoscopic transpapillary gallbladder drainage is a potentially effective bridge to surgery for perforated cholecystitis with localized peritonitis.
• This technique may serve as a non-surgical long-term management option for patients unsuitable for surgery.
• This case represents the first report of endoscopic transpapillary gallbladder drainage for perforated emphysematous cholecystitis.