What is a percutaneous cholecystostomy procedure?
A percutaneous cholecystostomy is a procedure to place a drainage catheter in the gallbladder through a tiny entry hole made in the stomach wall. The drainage tube will be connected to a collection bag which can be periodically emptied. The doctor usually removes the tube in about two to three weeks, after ensuring there is no further leakage.
A percutaneous cholecystostomy is a procedure to place a drainage catheter in the gallbladder through a tiny entry hole made in the stomach wall. The drainage tube will be connected to a collection bag which can be periodically emptied. The procedure is minimally invasive, performed with imaging guidance such as ultra-sonar scan and continuous X-ray (fluoroscopy).
Where is a cholecystostomy tube placed?
A cholecystostomy tube is placed inside the gallbladder. The gallbladder is a green, hollow, pear-sized organ beneath the liver. The gallbladder stores and concentrates the bile produced by the liver. Bile fluid helps the intestine digest the fats and fat-soluble vitamins in the food.
After a meal, the gallbladder squirts the bile through ducts into the small intestine, in response to signals from the vagus nerve. After it releases the bile it becomes empty and flat, similar to a deflated balloon.
What is a cholecystostomy used for?
When the flow of bile from the gallbladder to the intestine is obstructed, it leads to
- Gallbladder inflammation (cholecystitis)
- Bile duct inflammation (cholangitis)
- Bile fluid obstruction may be caused by
- Stricture in the bile duct
- Stones in the bile duct (choledocholithiasis)
- Gallstones (cholelithiasis)
- Benign or malignant tumors in the
- gallbladder
- bile duct
Percutaneous cholecystostomy is performed to decompress the gallbladder and drain the bile fluid out of the gallbladder. The procedure is performed to treat acute cholecystitis
- As an emergency procedure to prevent gallbladder rupture.
- As a temporary measure, for symptom relief in critically ill patients until they can withstand surgery for gallbladder removal (cholecystectomy).
- As a palliative measure in patients with malignancies.
- In pregnant women to prevent potential risks to the fetus.
Cholecystostomy is not a permanent solution for biliary problems for most people. The procedure is an immediate treatment for acute cholecystitis in people who cannot have the gallbladder removed (cholecystectomy).
The cholecystostomy drain tube is also a potential route for locating and removing gallstones in the bile duct using contrast dye and X-rays. The tube can be used to dissolve or extract stones.
How is a cholecystostomy performed?
An interventional radiologist usually performs a percutaneous cholecystostomy with the patient under local anesthesia and mild sedation. The procedure may be performed in a radiology lab unless the patient is already under critical care in the hospital. The procedure may take up to an hour.
Preparation
The patient may be required to
- Avoid eating anything for 8 hours prior to the procedure.
- Check with the doctor before taking any regular medications.
- Inform the doctor of any allergies.
- Inform the doctor if pregnant.
Procedure
The interventional radiologist
- Administers painkillers and mild sedation through an IV line attached to the patient’s arm.
- Uses the images on the ultrasonogram monitor for guidance and marks the place on the right, upper abdomen for tube insertion.
- May also use fluoroscopy imaging with contrast dye, for guidance.
- Administers local anesthesia on the chosen area.
- Inserts a needle with a guidewire through the stomach wall into the gallbladder via the
- abdominal lining (peritoneum) or
- liver
- Removes the needle, slides a flexible drain tube using the guidewire, and inserts it into the gallbladder.
- Collects bile sample for testing.
- Ensures that the tube is in the right place.
- Secures the tube with a suture on the skin at the entry hole.
- Connects the tube with an extension tube to a drainage bag which is strapped below waist level.
- Monitors the patient’s vital signs and the bile drainage for a few hours.
The patient should be able to leave the same day or the next, unless already hospitalized, or any complication arises. Before discharge, the patient will be taught to care for the drain site, and to flush and clean the tube and drainage bag.
How long does a cholecystostomy tube stay in?
Cholecystostomy may be the only treatment required for cholecystitis without gallstones or any other complications. The drain will be removed, after the inflammation is resolved. The doctor usually removes the tube in about two to three weeks, after ensuring there is no further leakage.
In patients who later need a cholecystectomy, the bile drain may remain in place until the patient is stabilized and prepared for a surgery.
In some patients the drain may be left permanently in place. The drainage tube will have to be changed every six to eight weeks.
What are the risks and complications of a percutaneous cholecystostomy?
A percutaneous cholecystostomy is mostly a safe and effective procedure. Complications may include:
- Hemorrhage and blood in the biliary tract (hemobilia)
- Bile leak resulting in inflammation of the peritoneum (peritonitis)
- Lung collapse (pneumothorax)
- Drain tube dislodgement
- Bowel perforation
- Gallbladder perforation
- Sudden drop in blood pressure and heart rate (vasovagal effects)
- Secondary infection and sepsis
- Failure of procedure, due to gallstones
- Recurrence of cholecystitis
