Seventeen high-risk
critically ill patients with suspected
cholecystitis underwent percutaneous transhepatic
cholecystostomy between 1981 and 1986 using Hawkins' needle guide system for gallbladder intubation.
Acute cholecystitis was documented in 15 patients, including 1 with common bile duct obstruction. Two other patients had common bile duct obstruction secondary to metastatic
cancer (one patient) and chronic pancreatic
fibrosis (one patient). There was rapid resolution of the signs and symptoms of
cholecystitis,
sepsis, or both in 16 of the 17 patients. One
critically ill patient with positive findings on blood culture and an organism resistant to triple
antibiotic therapy died soon after percutaneous
cholecystostomy. In the entire group of 17 patients, there was no evidence of bile leaks or other
catheter complications. Six patients subsequently underwent successful
cholecystectomy and two underwent common bile duct exploration without complications. One patient underwent cholecystojejunostomy, and in three patients, the
catheter was removed with no sequelae of
cholecystitis. Two remaining patients had the
catheter in place and were awaiting operation at last follow-up. Three of four patients who died within 30 days of percutaneous transhepatic cholangiographic
cholecystostomy died either from the terminal malignant condition (two patients) or from
arrhythmia (one patient with
cirrhosis). This review suggests that percutaneous
cholecystostomy is a safe and effective procedure for resolving
acute cholecystitis in high-risk patients. In addition, the technique of percutaneous transhepatic cholangiographic
cholecystostomy appears well suited for percutaneous dissolution of stones,
sclerosis of the gallbladder, or both in selected high-risk
critically ill patients.