Acute Cholecystitis
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
In case of patients who are not be suitable for emergent surgical treatment due to severe comorbidities or the severity of cholecystitis, due consideration for a percutaneous cholecystostomy or percutaneous transhepatic gallbladder drainage, should be considered as an alternative treatment to surgery if their disease does not respond to conservative measures [5]. Percutaneous transhepatic gallbladder drainage has been reported to have comparable outcomes to cholecystectomy in literature when performed for the appropriate indications. It may also be used as a bridge to surgery at the hospitals where complicated surgeries are difficult and/or surgeons at work do not have expertise in managing severe acute cholecystitis.
Gastrointestinal system
David A Lisle in Imaging for Students, 2012
Percutaneous cholecystostomy (drainage of the gallbladder) may be useful in the management of acute cholecystitis where the surgical risks are unacceptable. Percutaneous cholecystostomy is usually performed via US guidance. Gallbladder is punctured, a wire passed through the needle, and a drainage catheter placed in the gallbladder over the wire. Non-resolution of pyrexia within 48 hours may indicate gangrene of the gallbladder requiring surgery. A cholecystogram is performed once the acute illness has settled, with contrast material injected through the drainage catheter. Stones causing cystic duct obstruction may require surgery; otherwise the catheter is removed.
The Gallbladder and Bile Ducts
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
A cholecystostomy is rarely indicated but, if required, as many stones as possible should be extracted and a large Foley catheter (14 Fr) placed in the fundus of the gallbladder with a direct track externally. By so doing, stones retained in the gallbladder can be subsequently extracted with a choledochoscope.
‘Adrenal rush’ in a patient with Neurofibromatosis-1
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Samiha Khan, Beenish Fayyaz, Janki Patel
A 38-year-old female with history of NF-1 (diagnosed at the age of 13) presented to the emergency with right upper-quadrant abdominal pain, progressively worsening over the last 48 hours and associated with nausea and recurrent vomiting. Her vitals at the time of presentation included blood pressure of 224/133 and pulse of 98/min. Apart from typical features of NF-1 (café au lait spots and neurofibromas), the only significant examination findings were signs of dehydration and tenderness in the right upper quadrant of the abdomen. On questioning, she confirmed being diagnosed with hypertension 5 years back but was non-compliant to her medications as none helped improved her BP. She denied being investigated for secondary hypertension while the last anti-hypertensive prescribed to her was labetalol. It is possible if she had been compliant, she may have been diagnosed earlier. Due to concerns for high blood pressure and suspected cholecystitis, she was admitted to ICU for further management. Apart from leukocytosis of 19,000, the rest of her blood workup including bilirubin, liver enzymes and lipase was unremarkable while electrocardiogram had no acute changes. An urgent ultrasound of the abdomen showed cholelithiasis along with pericholecystic fluid suggestive of acute cholecystitis which was confirmed on CT abdomen/pelvis with contrast. She was immediately started on intravenous fluids and antibiotics while the general surgery team was consulted. Due to the patient being very sick, a cholecystostomy tube was placed to decompress the distended inflamed gall bladder.
Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis
Published in Scandinavian Journal of Gastroenterology, 2023
Junya Sato, Kazunari Nakahara, Yosuke Michikawa, Ryo Morita, Keigo Suetani, Akihiro Sekine, Yosuke Igarashi, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
Acute cholecystitis is diagnosed in 3–10% of patients who visit hospitals with abdominal pain [1–3]. Early laparoscopic cholecystectomy is the standard therapy for acute cholecystitis [4]. Gallbladder drainage is the treatment option for patients who cannot undergo early surgery. According to the Tokyo guidelines 2018 [5], gallbladder drainage is considered indicative of grade II (moderate) or grade III (severe) acute cholecystitis. The standard method of gallbladder drainage is percutaneous transhepatic gallbladder drainage (PTGBD). PTGBD is an effective treatment, but some patients are not suitable because of ongoing antithrombotic therapy, ascites, or anatomically inaccessible location [6].
Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective
Published in Scandinavian Journal of Gastroenterology, 2021
Wisam Sbeit, Anas Kadah, Amir Shahin, Tawfik Khoury
There were no more procedure or sedation related complications in the same session compared to the tow sessions' group. Several studies have reported on the safety of single session EUS and ERCP patients with choledocholithiasis [11,12] and pancreato-biliary disorders [13,14]. A recent meta-analysis reached the conclusion that combining EUS-fine needle aspiration with ERCP-based tissue sampling in the same session is superior to either method alone in malignant biliary strictures diagnosis [15]. Same session EUS gallbladder drainage and ERCP has also been shown to be safe and effective in patients with acute cholecystitis and concomitant choledocholithiasis [16].
Related Knowledge Centers
- Anesthesia
- Ascites
- Incision & Drainage
- Peritonitis
- Stoma
- Cholecystectomy
- Cholecystitis
- Gallbladder
- Incision & Drainage
- Coagulopathy
- Gastrointestinal Perforation