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Kim, Jo, and Park: The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation
Original Article

J Korean Soc Radiol 2017;77(6):372-381.

Published online: 19 January 2017

DOI: https://doi.org/10.3348/jksr.2017.77.6.372

The Efficacy of Preoperative Percutaneous Cholecystostomy for Acute Cholecystitis with Gallbladder Perforation

Bo Ra Kim, MD, Jeong-Hyun Jo, MD, Byeong-Ho Park, MD*,

Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea

*Corresponding author: Byeong-Ho Park, MD Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, 26 Daesingong-won-ro, Seo-gu, Busan 49201, Korea. Tel. 82-51-240-5371 Fax. 82-51-253-4931 E-mail: bhpark@dau.ac.kr

Received 12 May 20173 June 2017       Accepted 26 June 2017

Copyright © 2017 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Treatment of acute cholecystitis with gallbladder perforation remains controversial. We aimed to determine the feasibility of percutaneous cholecystosto-my (PC) in these patients.

Materials and Methods

We retrospectively reviewed patients who had acute cholecystitis with gallbladder perforation at a single institution. Group 1 (n = 27; M:F = 18:9; mean age, 69.9 years) consisted of patients who received PC followed by cholecystectomy, and group 2 (n = 16; M:F = 8:8; mean age 57.1 years) consisted of patients who were treated with cholecystectomy only. Preoperative details, in-cluding sex, age, underlying medical history, signs of systemic inflammatory re-sponse syndrome (SIRS), laboratory findings, body mass index, presence of gallstone, and type of perforation; treatment-related variables, including laparoscopic or open cholecystectomy, conversion to laparotomy, blood loss, surgical time and anesthesia time; and outcome, including postoperative complications and hospital stay were analyzed.

Results

There was no significant difference in preoperative details, treatment-re-lated variables, postoperative complications, and postoperative hospital stay. Howev-er, preoperative hospital stay (median, 14 days vs. 8 days; p < 0.05) and total hospital stay (median, 22 days vs. 14.5 days; p < 0.05) were significantly longer in group 1 than in group 2.

Conclusion

The preferred treatment of acute cholecystitis with gallbladder perfo-ration might be cholecystectomy without preoperative PC; however, preoperative PC can be a safe, optional treatment in elderly patients with signs of SIRS.

Keywords: Cholecystostomy, Cholecystitis, Acute, Cholecystectomy

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Fig. 1.
Algorithm for treatment decision in the patients having acute cholecystitis with gallbladder perforation in this study.
jksr-77-372f1.tif
Table 1.
Demographics and Initial Status of the Patients in the Two Groups
Group 1 Group 2
Patient Sex Age BT (°C) HR (/min) RR (/min) WBC (/mm3) SIRS Patient Sex Age BT (°C) HR (/min) RR (/min) WBC (/mm3) SIRS
1 M 68 38.2 97 20 10180 O 1 F 48 36.0 82 21 16470 O
2 F 70 36.5 78 20 11090 X 2 M 44 37.9 115 20 13740 O
3 M 63 36.6 92 20 13160 O 3 F 71 39.2 89 20 4590 X
4 M 71 38.2 109 20 20870 O 4 F 64 36.5 94 20 7060 X
5 M 58 36.7 103 20 6120 X 5 F 71 37.4 71 20 21010 X
6 M 76 38.5 95 20 20570 O 6 M 33 39.4 119 20 11120 O
7 M 71 38.0 98 20 9970 X 7 F 33 37.0 91 20 12610 O
8 M 79 38.0 140 20 21970 O 8 M 59 36.0 76 19 10350 X
9 M 58 36.4 74 20 12900 X 9 F 63 36.0 74 22 9930 X
10 F 70 37.0 88 22 22450 O 10 M 86 37.6 80 20 13180 X
11 M 72 36.6 100 22 15710 O 11 M 87 36.8 72 20 11110 X
12 M 78 38.0 97 20 9760 X 12 F 45 36.6 82 20 8200 X
13 F 81 38.2 92 20 20830 O 13 M 81 36.9 68 20 18730 X
14 M 69 36.4 92 20 9320 X 14 M 20 36.4 70 20 12190 X
15 F 56 37.0 102 20 15100 O 15 M 74 36.9 76 20 18430 X
16 F 67 36.6 85 20 19210 X 16 F 35 37.3 115 20 12210 O
17 M 59 36.7 98 20 10160 X
18 F 83 36.5 97 20 11010 X
19 F 71 37.3 112 20 12860 O
20 M 69 36.8 118 26 7830 O
21 M 71 37.2 87 20 14920 X
22 M 68 39.2 106 20 13800 O
23 M 77 37.4 102 20 11350 X
24 M 51 36.6 92 20 30820 O
25 F 78 37.7 107 24 23100 O
26 M 80 38.5 88 20 16960 O
27 F 74 36.4 68 20 14520 X

BT: body temperature, HR: heart rate, RR: respiratory rate, SIRS: systemic infiammatory responsary syndrome, WBC: white blood cell

Table 2.
Clinical Characteristics of the Patients in the Two Groups
Variables Group 1 (n = 27) Group 2 (n = 16) p-Value
Sex (%) 0.449
Male 18 (66.7) 8 (50.0)
Female 9 (33.3) 8 (50.0)
Age (years) 71 (67–77) 61 (37.3–73.3) 0.070
Underlying disease (%)
Diabetes 14 (51.9) 8 (50.0) 0.957
Hypertension 14 (51.9) 8 (50.0) 1.000
Heart disease 6 (22.2) 2 (12.5) 0.699
Lung disease 11 (40.7) 2 (12.5) 0.108
Ranal disease 4 (14.8) 3 (18.8) 1.000
Hepatic disease 21 (77.8) 12 (75.0) 1.000
Dementia or cerevral vascular accident 5 (18.5) 1 (6.2) 0.505
Pervious abdominal surgery 5 (18.5) 4 (25.0) 0.907
Malignancy 2 (7.4) 2 (12.5) 0.990
Others 5 (18.5) 1 (6.2) 0.505
Body temperature (°C) 37.2 (36.6–38) 36.9 (36.5–37.7) 0.385
Fever (body temperature > 37.2°C) (%) 13 (48.1) 6 (37.5) 0.717
Lab findings on admission
WBC (/mm3) 14520 (9970–20870) 12685 (10097.5–14912.5) 0.218
Leukocytosis (WBC > 10000/mm3) (%) 22 (81.5) 12 (75.0) 0.907
AST (IU/L) 43 (31–123) 31 (17.8–113.3) 0.080
AST > 40 IU/L (%) 13 (48.1) 3 (18.8) 0.109
ALT (IU/L) 39 (26–67) 23.5 (12–126) 0.148
ALT > 40 IU/L (%) 12 (44.4) 5 (31.2) 0.594
Total bilirubin (mg/dL) 1.2 (0.9–3.6) 0.9 (0.6–1.8) 0.027
Total bilirubin > 2.0 mg/dL (%) 7 (25.9) 2 (12.5) 0.510
CRP (mg/dL) 22.4 (8.3–33.4) 16.7 (10.7–19.3) 0.117
CRP > 0.5 mg/dL (%) 25 (92.6) 13 (100.0) 0.816
BMI (%) 22.3 (20.3–25.2) 25.1 (22.7–27.2) 0.163
> 25 9 (33.3) 7 (43.8) 0.721
< 18 3 (11.1) 0 (0.0) 0.445
Types of gallbladder perforation* (%) 0.429
Type I 8 (29.6) 3 (18.8)
Type II 19 (70.4) 13 (81.3)
Type III 0 (0.0) 0 (0.0)
Persence of gallstone on imaging (%) 21 (77.8) 15 (93.8) 0.345

* Modified Niermeir classification of gallbladder perforation.

ALT = serum alanine aminotransaminase, AST = serum aspartate aminotransferase, BMI = body mass index, CRP = C-reactive protein, WBC = white blood cell

Table 3.
Treatment-Related Variables in the Two Groups
Variables Group 1 (n = 27) Group 2 (n = 16) p-Value
Laparoscopic cholecystecomy (%) 16 (59.3) 8 (50.0) 0.785
Open cholecystectomy (%) 11 (40.7) 8 (50.0) 0.785
Open conversion (%) 4 (14.8) 5 (31.2) 0.372
Blood loss (mL) 500 (400–500) 400 (50–600) 0.512
Surgical procedure time (min) 120 (75–145) 147.5 (98.8–166.3) 0.428
Anesthesia time (min) 155 (115–180) 175 (142.5–200) 0.268
Table 4.
Complications and Hospital Stay in the Two Groups
Variables Group 1 (n = 27) Group 2 (n = 16) p-Value
Post-operative complications (%)
Surgical site infection 3 (11.1) 3 (18.8) 0.808
Biliary complications 0 0 -
Lung complications 2. (7.4) 1 (6.2) 1.000
Postoperative bleeding 1 (3.7) 1 (6.2) 1.000
Postoperative ileus 0 0 -
Would dehiscence 2 (7.4) 0 (0.0) 0.714
Complications requiring re-operation 2 (7.4) 0 (0.0) 0.714
Others 2 (7.4) 0 (0.0) 0.714
Hospital stay (days)
Preoperative hospital stay 14 (7–26) 8 (1–12.3) 0.001
Postoperative hospital stay 8 (6–14) 7.5 (6–12.8) 0.705
Total hospital stay 22 (18–36) 14.5 (10–23.5) 0.001
Table 5.
Relationship between Presence of SIRS & Treatment Outcome Variables
Complications & Hospital Stay SIRS O SIRS X p-Value
Group 1 & group 2 (with SIRS, n = 20; without SIRS, n = 23)
Postoperative complications (%)
Surgical site infection 3 (15.0) 3 (13.0) 1.000
Biliary complications 0 0 -
Lung complications 2 (10.0) 1 (4.3) 0.590
Postoperative bleeding 1 (5.0) 1 (4.3) 1.000
Postoperative ileus 0 0 -
Would dehiscence 0 (0.0) 2 (8.7) 0.491
Complications requiring re-operation 1 (5.0) 1 (4.3) 1.000
Others 1 (5.0) 1 (4.3) 1.000
Hospital stay (days)
Preoperative hospital stay 10 (6.3–23.5) 7 (5–13) 0.157
Postoperative hospital stay 5 (3–7) 7 (4–13) 0.255
Total hospital stay 16 (12–34.3) 14 (10–22) 0.387
Group 1 (with SIRS, n = 15; without SIRS, n = 12)
Postoperative complications (%)
Surgical site infection 3 (20.0) 0 (0.0) 0.231
Biliary complications 0 0 -
Lung complications 2 (13.3) 0 (0.0) 0.487
Postoperative bleeding 1 (6.7) 0 (0.0)
Postoperative ileus 0 0 -
Would dehiscence 0 (0.0) 2 (16.7) 0.188
Complications requiring re-operation 1 (6.7) 1 (8.3) 1.000
Others 1 (6.7) 1 (8.3) 1.000
Hospital stay (days)
Preoperative hospital stay 13 (7–29) 12.5 (6.8–18) 0.627
Postoperative hospital stay 5 (3–9) 7.5 (3.3–13.8) 0.556
Total hospital stay 20 (15–36) 19 (12.3–32.8) 0.807
Group 2 (with SIRS, n = 5; without SIRS, n = 11)
Postoperative complications (%)
Surgical site infection 0 (0.0) 3 (27.3) 0.509
Biliary complications 0 0 -
Lung complications 0 (0.0) 1 (9.1) 1.000
Postoperative bleeding 0 (0.0) 1 (9.1) 1.000
Postoperative ileus 0 0 -
Would dehiscence 0 0 -
Complications requiring re-operation 0 0 -
Others 0 0 -
Hospital stay (days)
Preoperative hospital stay 9 (1.5–11.5) 6 (1–7) 0.529
Postoperative hospital stay 4 (2.5–6) 6 (4–10) 0.152
Total hospital stay 12 (5–17) 10 (7–20) 0.690
SIRS = systemic inflammatory response syndrome
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