Aims and objectives
The management of acute cholecystitis includes medical,
surgical and interventional radiology options. In appropriate patients percutaneous cholecystostomy (gallbladder drain) insertion offers an effective and excellent treatment option. The UK National Institute for Health and Care Excellence (NICE) and Tokyo cholecystitis guidelines provide advice on patient selection for cholecystostomy. We present a retrospective analysis of cholecystostomy practice at our centre,
including imaging findings,
frequency and appropriateness of insertion andperforming practitioner.
Methods and materials
All patients who underwent cholecystostomy at our centre from 1st January 2014 to 31st December 2016 were included in the study. Cases were retrospectivelyidentified through interrogation of the radiology information system using all codes for cholecystostomy at our centre which are ICHOSD,
UABDOD and UDRAID.
The clinical details on imaging requests andcholecystostomy referrals were reviewed. Clinical features of sepsis,
right upper quadrant pain,
other abdominal pain,
temperature andpatient's age were recorded for each case.
The findings of radiological studies performed prior to cholecystostomy wererecorded. The...
Results
During the three year study period,
151 patients underwentcholecystostomy insertion. Thirty-eight were performed in 2014 (25%),
61 performed in 2015 (40%) and 52 performed in 2016 (34%).
General surgery referred 113 patients (75%). The remaining 38 (25%) were referred froma variety of hospital specialties: ten (7%) from general internal medicine; eight (5%) from gastroenterology; seven (5%) from old age medicine; three (2%) from renal medicine; two (1%) from colorectal surgery; two (1%) from the emergency department. Six specialities each referred one patient (4% of all...
Conclusion
The UK National Institute for Health and Clinical Excellence (NICE) guideline on the management of acute cholecystitis [2] states that percutaneous cholecystostomy should be offered to manage gallbladder empyema for patients in whom surgery is contraindicated at presentation and conservative management is unsuccessful. It should only be offered for patients with moderate or severe cholecystitis. The Tokyo guidelinesgrade cholecystitis into mild,
moderate and severe [1].
Patients may not be a surgical candidate for a number of reasons,
including multiple comorbidities,
poor overall physical health,
patients...
Personal information
T.
Peachey,
BA(Oxon) MBChB(Hons) AFHEA FRCR
Sheffield Teaching Hospitals NHS Foundation Trust
Northern General Hospital
Herries Road
Sheffield
S5 7AU
[email protected]
[email protected]
References
[1] New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines.
M Yokoeet al. J Hepatobiliary Pancreat Sci (2012) 19:578–585. DOI 10.1007/s00534-012-0548-0
[2] Gallstone disease: diagnosis and management NICE clinical guideline 188,
UK National Institute of Health and Care Excellence,
October 2014
[3] Percutaneous cholecystostomy: The radiologists role in treating acute cholecystitis.
MW Little et al. Clin Radiol.
2013 Jul;68(7):654-60.
doi: 10.1016/j.crad.2013.01.017.
Epub 2013 Mar 21