PERCUTANEOUS CHOLECYSTOSTOMA, COMBINED WITH DRAINAGE OF HEPATIC ABSCESS

Purpose: Evaluation the results of the performed percutaneous cholecystostoma and external drainage under US control to acute cholecystitis compicated with hepatic abscesses in patients with high operative risk, caused by severe, septic status and pathology of the elderly. Methods and Materials: Different catheters (4–7 F) were installed a modo Seldinger or directly (intercostal or transabdominal approach) into the abscess cavity and the gallbladder. An active aspiration and daily lavage was performed until elimination of the infection (bacteriological and cytological analysis). Cholecystostoma and drainage of hepatic (biliary) abscess were installed to 21 patients (13 female and 8 male, age from 62 to 87 years) with acute cholecystitis (19 with calculous and 2 with noncalculous) in severe septic status and high operative risk during the last five years. 3 patients with 2 abscess cavities each were treated. The duration of the treatment was from 6 to 21 days (average 11,3 days). Results: Complete recovery was achieved in 17 patients-effectiveness rate 80,9%. Two patients (gangrenORS cholecystitis) were operated because of incompletely effective drainage of the abscess cavity (7–10th day) but in improved general status and 1 on the 8th day because of suspections for biliary peritonitis. Exitus letalis occurred in one patient on the 6th day because of a heart attack. Cholecystectomia in stabilized general status was performed in 10/17 patients-58,8% during the next 3 months. 7 patients refused operation. Conclusions: The combination between percutaneous cholecystostoma and external drainage under US control to acute cholecystitis compicated with hepatic abscess is highly effective in patients, mainly older, in which the biliary pathology has specific characteristics, requiring an alternative approach to the treatment because of the high operative risk.