Percutaneous Cholecystostomy

Background and indications

Percutaneous cholecystostomy is gallbladder drainage by percutaneous approach under imaging guidance. It is indicated in acute cholecystitis in high surgical risk patients (critically ill, hemodynamically unstable, severe comorbidities) as a temporary alternative to cholecystectomy, and in acalculous cholecystitis in ICU patients.

Pre-procedure assessment

Assessment includes abdominal ultrasound (cholecystitis signs: wall thickening, impacted stone in infundibulum, gallbladder distension, positive sonographic Murphy sign), blood panel (CBC, CRP, liver function), and surgical risk evaluation (ASA score, medico-surgical discussion).

Procedure

Under local anesthesia and ultrasound (or CT) guidance, a pigtail drain (8-10F) is inserted into the gallbladder via transhepatic route (preferred — traversing hepatic parenchyma to reduce bile leak risk) or transperitoneal route. Infected bile is aspirated and sent for bacteriology. The drain is secured and connected to a collection bag. The procedure takes 20-30 minutes.

Results and scientific evidence

Percutaneous cholecystostomy offers rapid clinical relief (within 24-48h) in 85-95% of cases. It stabilizes the patient and defers cholecystectomy to 6-8 weeks under better conditions ("cold" cholecystectomy). For permanently non-operable patients, the drain can be maintained long-term or removed after cholecystitis resolution. Peri-procedural mortality is 0.5-1%, versus 5-15% for emergency cholecystectomy in critical patients.

Risks and complications

Bile leak (3-5%, reduced by transhepatic approach), drain displacement (5-10%), transient bacteremia (5-10%), hemorrhage (< 2%), biliary peritonitis (< 1%).

Recovery

Clinical improvement in 24-48h. Drain maintained 3-6 weeks (tract maturation time). Elective cholecystectomy later or drain removal after resolution.

Practical information

The procedure is performed as an inpatient (acute cholecystitis context). It is performed by an interventional radiologist, in coordination with the visceral surgeon.