Percutaneous cholecystostomy for acute cholecystitis

Case contributed by Dr Omar Bashir


Post operative sepsis and abdominal pain

Patient Data

Age: 75
Gender: Male

There is a small volume of ascites and a right pleural effusion. The images also demonstrate gallbladder wall thickening and gallstones. 

The CT findings confirmed clinical diagnosis of acute cholecystitis. Due to worsening sepsis, the patient was referred to interventional radiology for percutaneous cholecystostomy.

A. The fundus of the gallbaldder was punctured under ultrasound guidance using an 18 gauge needle. Contrast injection through the needle confirms satisfactory needle position.

B. An 0.035" guide wire was passed through the needle into the gallblader.

C. The tract was dilated with a 10 Fr dilator

D. A 10 Fr pigtail catheter was inserted over the guide wire. Purulent bile was aspirated from the gallbladder, a specimen was sent for microbiological tests.

E. Contrast injection through the drain demonstrates intraluminal filling defects, consistent with gallstones. No contrast is seen to flow through the cystic duct, indicating stone impaction, 

F. The gallbladder is decompressed at the end of the procedure.

Case Discussion

Percutaneous cholecystostomy is a safe and effective procedure in high risk patients with severe acute cholecystitis.

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Case information

rID: 22430
Published: 31st Mar 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included