Percutaneous cholecystostomy: anatomic considerations

In 100 consecutive patients undergoing abdominal computed tomography, the anatomic relationships among the gallbladder fundus, liver, and right hemicolon were evaluated to assess the feasibility of direct transperitoneal versus percutaneous transhepatic cholecystostomy. In only 17% of patients was there no interposition of colon or liver between the skin and the gallbladder fundus. In 13% of patients the right hemicolon lay between the gallbladder fundus and skin. In the remaining 70% of patients, the gallbladder fundus was positioned posterior to the liver margin. Thus, in 83% of patients studied, percutaneous cholecystostomy would necessitate a transhepatic approach.