Percutaneous cholecystostomy as the sole treatment in critically ill and elderly patients

• Published in: Radiologia medica Vol. 117; no. 5; pp. 772 - 779
• Main Authors: Carrafiello, G., D’Ambrosio, A., Mangini, M., Petullà, M., Dionigi, G. L., Ierardi, A. M., Piacentino, F., Fontana, F., Fugazzola, C.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.08.2012
• Subjects: Abdominal Radiology; Aged; Aged, 80 and over; Cholecystitis, Acute - diagnostic imaging; Cholecystitis, Acute - surgery; Cholecystostomy - methods; Comorbidity; Contrast Media; Critical Illness; Diagnostic Radiology; Female; Humans; Imaging; Interventional Radiology; Iopamidol; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Radiologia Addominale; Radiology; Treatment Outcome; Ultrasonography, Interventional; Ultrasound; Guida ecografica; Pazienti critici e anziani; Acute cholecystitis; Critically ill and elderly patients; Colecistostomia percutanea; Percutaneous cholecystostomy; Ultrasonographic guidance; Colecistite acuta
• DOI: 10.1007/s11547-012-0794-2
• ISSN: 0033-8362

Purpose This study was done to investigate the effectiveness and clinical outcome of percutaneous cholecystostomy (PC) of treating acute cholecystitis in critical ill and elderly patients. Materials and methods In the last 3 years, PC was performed on 30 elderly and critically ill patients (17 men, 13 women; mean age 78.6, range 57–97 years) with acute cholecystitis and comorbid diseases. Results Technical success was 30/30 (100%). Clinical effectiveness was 30/30 (100%), with statistically significant reductions in while blood cell (WBC) count, C-reactive protein (CRP) and fever. Mean WBC upon admission (19.87×10 3 ±1.61×10 3 /μl), axillary temperature (38.2±0.11 °C), and CRP (248.7±4.76 mg/l) values were significantly decreased in the 72 h following PC [12.9×10 3 ± 1.05×10 3 /μl ( p ≤0.0001), 37 ± 0.04 °C ( p ≤0.0001), 113.5 ± 3 mg/l ( p ≤0.0001), respectively]. Clinical and ultrasonographic (US) signs of acute cholecystitis decreased in all patients. There were no major complications or procedure-related deaths, and the morbidity rate was low (3/30; 10%). Conclusions PC appears to be a fast, easy and effective treatment for the acute phase of cholecystitis in elderly and critically ill patients. Procedure-related morbidity and mortality rates are very low compared with surgery. Conservative treatment for patients who are not eligible for surgery is acceptable.