Percutaneous cholecystostomy in the critically ill burn patient

Area of Science:

• Critical Care Medicine
• Interventional Radiology
• Surgical Gastroenterology

Background:

• Critically ill burn patients often present with fever and rising cholestatic chemistries, raising suspicion for acute cholecystitis.
• Diagnosing acute cholecystitis in this vulnerable population can be challenging due to confounding factors.

Purpose of the Study:

• To evaluate the utility of percutaneous cholecystostomy in diagnosing and managing acute cholecystitis in critically ill burn patients.
• To assess the safety and efficacy of this minimally invasive procedure in a specialized patient group.

Main Methods:

• Retrospective review of patients admitted to a regional adult burn unit over a 2.5-year period.
• Identification of patients with suspected acute cholecystitis, with five managed via percutaneous cholecystostomy.
• Ultrasound-guided percutaneous transhepatic cholecystostomy performed at the bedside or in the ultrasonography suite.

Main Results:

• All patients exhibited sonographic signs consistent with acute cholecystitis.
• Percutaneous cholecystostomy was performed without complication in five patients.
• Two patients responded well to gallbladder drainage, while two did not, aiding in diagnosis.
• One patient died from unrelated multiple organ failure; others were discharged after catheter removal or interval cholecystectomy.

Conclusions:

• Bedside percutaneous cholecystostomy is a valuable tool for evaluating and managing critically ill burn patients with suspected acute cholecystitis.
• The procedure is minimally invasive and facilitates diagnosis, potentially avoiding more invasive interventions.
• It offers a safe and effective option for this challenging patient cohort.