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Treatment of Acute Cholecystitis in Non-Critically Ill Patients at High Surgical Risk

Comparison of Clinical Outcomes After Gallbladder Aspiration and After Percutaneous Cholecystostomy

Shailendra Chopra1, Gerald D. Dodd, III1, Amy L. Mumbower1, Kedar N. Chintapalli1, Wayne H. Schwesinger2, Kenneth R. Sirinek2, James P. Dorman2 and Hyunchul Rhim1

1 Department of Radiology, Mail Code 7800, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229.
2 Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229.



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  		Fig. 1A. —64-year-old woman with acute cholecystitis, a poor risk for surgery because of severe lung disease, who was treated successfully with gallbladder aspiration. Arrowheads indicate position of focal zone of sonographic transducer. Sonogram shows distended gallbladder. Note wall thickening (short arrow) and large stone in neck (long arrow) of gallbladder.

 


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  		Fig. 2A. —48-year-old man with acute cholecystitis, a poor risk for surgery because of poor cardiac status, who was treated successfully with percutaneous cholecystostomy using the Seldinger technique. Sonogram shows distended gallbladder. Note wall thickening (short arrow) and sludge in gallbladder neck (long arrow).

 


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  		Fig. 1B. —64-year-old woman with acute cholecystitis, a poor risk for surgery because of severe lung disease, who was treated successfully with gallbladder aspiration. Arrowheads indicate position of focal zone of sonographic transducer. Sonogram shows 18-gauge needle inserted through transhepatic route. Note tip of needle (arrow) in gallbladder lumen.

 


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  		Fig. 1C. —64-year-old woman with acute cholecystitis, a poor risk for surgery because of severe lung disease, who was treated successfully with gallbladder aspiration. Arrowheads indicate position of focal zone of sonographic transducer. Sonogram shows empty and collapsed gallbladder (arrow) after aspiration of contents and removal of needle.

 


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  		Fig. 2B. —48-year-old man with acute cholecystitis, a poor risk for surgery because of poor cardiac status, who was treated successfully with percutaneous cholecystostomy using the Seldinger technique. Sonogram shows 18-gauge needle inserted through transhepatic route. Note tip of needle (arrow) in gallbladder lumen.

 


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  		Fig. 2C. —48-year-old man with acute cholecystitis, a poor risk for surgery because of poor cardiac status, who was treated successfully with percutaneous cholecystostomy using the Seldinger technique. Sonogram shows curled distal end of guidewire (arrow) in gallbladder lumen.

 


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  		Fig. 2D. —48-year-old man with acute cholecystitis, a poor risk for surgery because of poor cardiac status, who was treated successfully with percutaneous cholecystostomy using the Seldinger technique. Sonogram shows distal end of pigtail catheter (arrow) locked in position within gallbladder lumen.

 

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