Percutaneous Aspiration, Lavage and Antibiotic Instillation in Failure of Conservative Management of Acute Cholecystitis

Abstract

This study examined whether, at failure of conservative management of acute cholecystitis, ultrasound-guided percutaneous aspiration and lavage of the gallbladder followed by intraluminal instillation of 500 mg ampicillin with 40 mg gentamicine (PALA) has advantages over cholecystostomy. In 53 PALA patients (41 women and 12 men, age range 25-59 years, mean 36) and 50 cholecystostomy patients (40 women and 10 men, age range 22-59 years, mean 35) who were fully evaluable, both procedures were equally effective in controlling an acute attack of cholecystitis within 24 h; however, PALA offered distinct gains. The procedure produced no sepsis, whereas cholecystostomy was associated with chest infection in 3 patients (6 %) and wound infection in 8 patients (16 %). PALA avoided an external biliary fistula and enabled a significantly (p