cholecystostomy for acute aca Icu lo us c ho lecyst i t is
The effectiveness and long-term results of percutaneous cholecystostomy for acute acalculous cholecystitis are evaluated. Fifteen patients with acute acalculous cholecystitis were treated prospectively by this procedure, using a pigtail catheter successfully placed under ultrasonographic and juoroscopic guidance. Prompt relief of the signs and symptoms of cholecystitis was achieved in 14 patients. One required emergency cholecystectomy for uncontrolled bleeding after drainage. Another patient underwent prophylactic cholecystectomy before further chemotherapy for leukaemia. The remaining 13 patients required no further surgery. Morbidity and mortality rates were 13 per cent and nil respectively. Long-term follow-up showed no recurrence of cholecystitis after removal of the catheter. Percutaneous cholecystostomy is a safe, efSective and usually dejinitive procedure for the treatment of acute acalculous cholecystitis.
Acute acalculous cholecystitis is a serious condition occurring in critically ill patients. The first case was reported' in 1844 and the incidence is increasing2s3. Risk factors include severe trauma or burns, major surgery, long-term fasting with or without total parenteral nutrition, sepsis, diabetes mellitus, atherosclerotic vascular disease, systemic vasculitis and acquired immune deficiency syndrome4-14.
Many surgeons recommend early cholecystectomy or early surgical cholecystostomy2~3~5 7-9*15s16, while some advocate percutaneous cholecystostomy for critically ill patients with acute c h ~l e c y s t i t i s ' ~~' ~ 2 6 . However, the number of patients with acute acalculous cholecystitis treated by percutaneous to clarify the merits and demerits of the procedure. Moreover, long-term follow-up after removal of the percutaneous catheter has not been reported.
Experience of percutaneous transhepatic cholecystostomy in a large series of 15 patients with acute acalculous cholecystitis is reported. The aims were to evaluate the early safety and efficacy and long-term results of percutaneous drainage. drainage is too small (eight or fewer in each series'4~'8~19,21~22,24 1