Although percutaneous cholecystostomy historically is an alternative to cholecystectomy, it is typically performed as a bridge to gallbladder removal. As a low mortality procedure, it proves itself a valuable tool in morbid patients such as the elderly and the critically ill who present with acute cholecystitis and as an alternate route for biliary access. In high-risk patients, PC can be performed at the patient’s bedside in patients who are too unstable to be transported outside the ICU. PC is performed using ultrasound, CT, or fluoroscopic guidance; however, bedside PC can only be performed using ultrasound. Ultrasound is readily available and portable and allows for real-time imaging. A 2010 study performed by Donkol et al. demonstrated success rates for CT (93%), US (46%), and fluoroscopy (62%). Though US had the lowest success rate, it remains the only option for those critically ill who cannot tolerate transportation or an immediate cholecystectomy. Contraindications of PC include hemorrhage, pericholecystic abscess, gallbladder tumor, etc. Complications include bile leak, hemorrhage, sepsis, bowel perforation, etc. The gallbladder is a small organ with much pathology. Having the knowledge and skill to adequately perform this procedure is essential, especially in patients with septic shock in need of source control.
Part of the book: Bedside Procedures