Emphysematous cholecystitis managed with percutaneous cholecystostomy compared to cholecystectomy or medical management: a 10-year single center experience

To describe outcomes of percutaneous cholecystostomy (PC), cholecystectomy, and medical management (MM) for emphysematous cholecystitis at our institution.

A retrospective review of patients treated with PC, cholecystectomy, or MM for emphysematous cholecystitis was conducted. Clinical outcomes, including hospital length of stay, complications, conversion to cholecystectomy following PC, and overall mortality, were analyzed. Fisher's exact test was used for categorical variables, and Kruskal-Wallis and Mann-Whitney tests for continuous variables in three and two groups, respectively. Kaplan-Meier analysis evaluated conversion to cholecystectomy and overall survival.

Fourteen patients underwent PC (median age, 68.6 years), 13 had cholecystectomy (median age, 69.1), and 7 received MM (median age, 80.0). The PC group had a significantly longer hospital stay (median, 10 days) compared to cholecystectomy (median, 4 days; P = 0.009) and a trend toward significance versus MM (7 days; P = 0.077). Complications were not significantly different among the three groups (P = 0.254). Eleven patients (79%) converted to cholecystectomy following PC at a median of 2.3 months. Overall mortality was similar among the groups (P = 0.270).

PC did not demonstrate significant differences in mortality compared to cholecystectomy or MM. PC was associated with increased length of stay and allowed conversion to cholecystectomy at a median of 2.3 months in the majority of patients when clinically appropriate.