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Percutaneous Cholecystostomy Tube Leading to a "Floating" Gallbladder: A Case Report
Christopher Reilly1, Saraswati Dayal2, Chinwe Ogedegbe3
1Emergency Medicine / General Surgery, St. George's University School of Medicine, St. George, GRD.
Insights
This case report details a rare "floating gallbladder" complication after cholecystostomy tube placement for acute cholecystitis. It highlights the need for careful risk assessment when choosing between tube placement and surgery in high-risk patients.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Medical Case Reports
Background:
- Acute cholecystitis management in patients with comorbidities often involves surgical intervention or cholecystostomy tube placement (CTP).
- Current literature lacks definitive recommendations comparing cholecystectomy and CTP for these high-risk patients.
- Decision-making relies heavily on surgeon's judgment and risk assessment indices.
Observation:
- A case of acute calculous cholecystitis managed initially with CTP in an elderly patient with significant comorbidities.
- Complications necessitated a cholecystectomy after 10 weeks, revealing an atraumatic, ruptured, chronically inflamed gallbladder detached and free-floating in the peritoneum.
- The gallbladder was successfully removed after extensive lysis of peritoneal adhesions.
Findings:
- This represents the first documented case of a
- floating gallbladder
- as a complication of CTP for acute cholecystitis in English medical literature.
- The patient experienced an uncomplicated recovery following the cholecystectomy.
- The case underscores the rare but significant potential complications associated with CTP.
Implications:
- The occurrence of a
- floating gallbladder
- emphasizes the critical need for thorough risk-benefit analysis when considering CTP versus immediate cholecystectomy in elderly or comorbid patients.
- This case adds to the understanding of management strategies for acute cholecystitis in complex patient populations.
- Further research may be warranted to establish clearer guidelines for managing acute cholecystitis in high-risk patients.
Abstract:
In patients with significant comorbid conditions, acute cholecystitis is managed through surgical intervention or with cholecystostomy tube placement (CTP). The literature is not definitive in its recommendations for cholecystectomy versus cholecystostomy. This case report describes a presentation of acute calculous cholecystitis managed with CTP. Over a 10-week period, due to complications with the tube, the decision was made to perform a cholecystectomy. Upon open surgical exploration, an atraumatic, ruptured, and chronically inflamed gallbladder was found without attachment to the subhepatic plate and, in essence, free "floating" in the peritoneum. To our knowledge, this is the first-known documented case report in the English medical literature. An elderly woman, with significant co-morbidities, following two months of antibiotic treatment for acute cholecystitis and subsequent percutaneous cholecystostomy tube placement and re-placements, underwent elective laparoscopic cholecystectomy, which was converted to open surgery. Upon exploration, a detached, "floating" gallbladder was found posterior to the transverse colon and removed after lysing extensive peritoneal adhesions. Subsequent to the cholecystectomy, the patient had uncomplicated recovery. The literature does not present a clear consensus on CTP use vs early cholecystectomy in high-risk patients with acute cholecystitis. This management decision is based primarily on the surgeon's clinical judgment and the use of evidence-based risk assessment indices. The "floating gallbladder" is a rare, benign complication that affirms the importance of extensively assessing the risks and benefits of CTP as compared to cholecystectomy in the elderly and/or comorbid patient.