Perforation as a cause of failure in the conservative treatment of acute cholecystitis: Is percutaneous cholecystostomy a sufficient treatment?

Abstract

Purpose: To evaluate the efficacy and safety of percutaneous cholecystostomy in acute cholecystitis cases with high surgical risk that were treated conservatively and developed perforation. Materials and Methods: Between July 2013 and May 2018, 20 acute cholecystitis cases with high surgical risk who underwent conservative treatment and presented with perforation were included in the study. The patients diagnosed with acute cholecystitis based on clinical, laboratory and ultrasonography at the time of presentation received conservative treatment. Upon development of perforation, percutaneous cholecystostomy (PC) was performed.Results: After 3.65 (2-8) days of conservative treatment, the patients with no improvement in clinical and/or laboratory findings were considered to have complicated cholecystitis and underwent additional imaging procedures. In 20 patients, gallbladder perforation was observed, and a total of 22 catheters were placed. During the procedure, the drainage catheter was successfully inserted in all patients with a technical success rate of 100%. One (5%) patient that was intubated, classified as ASA V, and had grade III cholecystitis and septic shock, died three days after the procedure. Clinical success was calculated as 95%. In addition, two (10%) patients had catheter dislocation as late, minor complications.Conclusions: For the treatment of gallbladder perforations that may develop during the conservative treatment of acute cholecystitis and result in significant mortality and morbidity rates, PC is an effective and safe treatment method, especially inhigh surgical risk patients.