Bedside Ultrasound-Guided Percutaneous Cholecystostomy in Critically Ill Patients-Outcomes in 51 Patients.
Rozil GandhiKunal GalaMohd ShariqAditi GandhiManish GandhiAmit ShahPublished in: The Indian journal of radiology & imaging (2023)
Purpose The aim of this study was to report technical and clinical success of bedside ultrasound-guided percutaneous cholecystostomy (PC) tube placement in intensive care unit (ICU). Materials and Methods This is a retrospective study of 51 patients (36 males:15 females, mean age: 67 years) who underwent ultrasound-guided PC from May 2015 to January 2020. The indication for cholecystostomy tube placement, comorbidities, imaging finding, technical success, clinical success, timing of surgery post-cholecystostomy tube placement, indwelling catheter time, complications, and follow-up were recorded. Results Indications for cholecystostomy tube placement were acute calculous cholecystitis ( n = 43; 84.3%), perforated cholecystitis ( n = 5; 9.8%), and emphysematous cholecystitis ( n = 3; 5.9%). Most of the patients had multiple comorbidities; these were diabetes mellitus, hypertension, cardiovascular disease, chronic renal disease, underlying malignancy, and multisystem disease with sepsis. All patients had undergone PC through transhepatic approach under ultrasound guidance in ICU. Technical success rate of the procedure was 100%. Clinical success rate was 92.1% (47/51) and among these 44/51 (86.2%) patients underwent definitive elective cholecystectomy, 3/51 (5.9%) patients had elective tube removal. Three of fifty-one (5.9%) patients did not improve; among these two underwent emergency surgery, while there was 1/51 (1.9%) mortality due to ongoing sepsis and multiorgan dysfunction. There were no procedure-related mortalities or procedure-related major complications. One patient had bile leak due to multiple attempts for cholecystostomy placement. Mean tube indwelling time was 13 days (range: 3-45 days). Conclusion Ultrasound-guided PC can be safely performed in ICU in critically ill patients unfit for surgery with high technical and clinical success rates. Early laparoscopic cholecystectomy should be preferred after stabilization of clinical condition following cholecystostomy.
Keyphrases
- ultrasound guided
- intensive care unit
- end stage renal disease
- cardiovascular disease
- newly diagnosed
- ejection fraction
- minimally invasive
- chronic kidney disease
- prognostic factors
- healthcare
- magnetic resonance imaging
- emergency department
- type diabetes
- oxidative stress
- photodynamic therapy
- patients undergoing
- patient reported outcomes
- acute kidney injury
- computed tomography
- cardiovascular events
- drug induced
- percutaneous coronary intervention
- case report
- respiratory failure
- coronary artery bypass
- rectal cancer