Current therapeutic approach to acute acalculous cholecystitis]

Image-guided percutaneous transhepatic cholecystostomy (PTC) was suspected Acute Acalculous Cholecystitis (AAC). Seven of them developed AAC at home while eight patients developed the disease while hospitalized by critical illness. We performed PTC with Seldinger technique, guided: 13 by US CT. In every cases the catheter was placed successfully AAC was confirmed in 14/15 patients. No severe complications were related to the procedure. All but 3 improved following PTC: 2 required cholecystectomy because of diffuse gallbladder gangrene and one died by sepsis 48 hs after PTC. Light complications were: 1 homobilia and fever by 36 hs. In this series mobility was 35% and mortality 21%. Thus 9 patients with AAC were cured with PTC and are alive and symptom-free without surgery. PTC failed in 3/14 patients and other 2 died by causes unrelated to biliary disease. We conclude that PTC is a safe and effective temporary method for definitive treatment of AAC. Surgery is limited to that cases with generalized peritonitis and those when PTC has fallen.