Indications and limitations of percutaneous cholecystostomy for acute cholecystitis

Percutaneous cholecystostomy (PC) was used as an alternative to operative therapy in 21 elderly or critically ill patients with suspected acute cholecystitis. All had associated disabling diseases, ten (48 percent) were older than 65 years, nine (43 percent) were in the intensive care unit and eight (38 percent) were recovering from recent operations. Among the 21 patients, 18 had cholecystitis (eight calculous and ten acalculous); in three patients, the procedure was only diagnostic. In 16 of 18 patients with acute cholecystitis, immediate relief of symptoms and significant improvement of laboratory signs of cholecystitis occurred. Persistent signs of peritonitis and uncertainty of diagnosis led to cholecystectomy without complication in one patient. Colonic perforation, as a result of technical complications, necessitated laparotomy in another patient. No other complication of PC was noted. Mortality rate of a patient with cholecystitis, treated by PC, was 5.5 percent (one of 18). Among ten patients with acalculous cholecystitis, only one patient underwent cholecystectomy because of a direct complication of PC. The other nine patients are alive and symptom-free with an intact gallbladder after a mean follow-up period of 16 months. Among eight patients with calculous cholecystitis, four later underwent cholecystectomy, three died from underlying disease, and one patient had stones extracted percutaneously. These results indicate that PC is an effective temporary measure in elderly or critically ill patients with acute cholecystitis and, under close clinical supervision, a safe alternative to surgical intervention. In patients with acalculous cholecystitis, PC can be used as an immediate and definitive therapy, and cholecystectomy can be avoided.