Percutaneous Cholecystostomy for the Diagnosis and Treatment of Acute Calculous and Acalculous Cholecystitis

Purpose: To determine the safety, efficacy, and diagnostic utility of percutaneous cholecystostomy in patients with suspected calculous or acalculous cholecystitis. Patients and Methods: Percutaneous cholecystostomy guided with ultrasound (US) was performed in 58 consecutive hospitalized patients with suspected acute cholecystitis (28 with calculous, 30 with acalculous disease) who were not surgical candidates. Results: The gallbladder was successfully catheterized in all 58 patients; 48 patients (83%) had a final diagnosis of acute cholecystitis. Clinical benefit was seen in 26 of 28 patients (93%) with calculous cholecystitis and in 16 of 20 patients (80%) with acalculous disease. The six patients who did not respond had pathologic evidence of transmural inflammation, and five had a gangrenous wall. The gallbladder was excluded as the source of sepsis in 10 patients with suspected acalculous cholecystitis. These patients' conditions did not improve after percutaneous cholecystostomy. Of the 48 patients with cholecystitis, 18 underwent cholecystectomy, 25 recovered and had their catheters removed, and five died of other causes with their catheters in place. There was one major complication, and seven minor complications. Conclusion: Percutaneous cholecystostomy is efficacious in both calculous and acalculous cholecystitis, but it may be most useful in the diagnosis of acalculous cholecystitis.