Percutaneous Cholecystectomy in the Intensive Care Patient

The diagnosis of acute cholecystitis in the intensive care patient is often problematic. While most patients with acute cholecystitis present with fever, increased white count, or symptomatology pertaining to the gallbladder, occasionally these patients may be comatose and often present a diagnostic dilemma. Surgical cholecystectomy is the treatment of choice for acute cholecystitis, but this therapy carries with it a high mortality rate in the desperately ill patient. Thus surgical cholecystostomy has been advocated as a temporizing procedure to be performed until these patients stabilize. More recently percutaneous cholecystostomy, performed at the patient's bedside under ultrasound guidance, has been successfully performed using small-size catheters. This is a low-risk temporizing procedure when performed by well-trained personnel. In fact, percutaneous cholecystostomy has been shown to be a definitive treatment in patients with acute acalculous cholecystitis. Patients with calculous cholecystitis may require more definitive therapy, such as cholecystectomy. Presented is a review of the development and the current applications of percutaneous cholecystostomy in intensive care patients with suspected acute cholecystitis.