Cholecystostomy: Procedure, Indications, and Clinical Pearls

What Is a Cholecystostomy?

A percutaneous cholecystostomy (PC) is an image-guided procedure placing a drainage catheter through the abdominal wall into the gallbladder lumen to decompress and drain infected or obstructed bile. It serves as a bridge to definitive surgery or definitive palliation.

Primary Indications

• Acute calculous cholecystitis in high-surgical-risk patients (ICU, severe cardiopulmonary disease, advanced age).
• Acalculous cholecystitis (critically ill, trauma, burns, prolonged fasting, vascular compromise).
• Gallbladder empyema or perforation with sepsis.
• Malignant biliary obstruction with cholangitis when ERCP fails or is unavailable.
• Palliative decompression in unresectable cancer.

Procedure Overview

1. Ultrasound or CT guidance; local anesthesia ± conscious sedation.
2. Transhepatic (preferred—tamponades tract) or transperitoneal approach.
3. 8–14 Fr locking pigtail catheter placed; bile sent for culture.
4. Catheter flushed daily; output monitored.

Outcomes and Timeline

• Clinical improvement in 80–90% within 24–48 hours (fever down, WBC down, pain down).
• Catheter remains 3–6 weeks minimum to form mature tract.
• Cholangiogram via catheter confirms cystic duct patency before removal.
• Definitive cholecystectomy (laparoscopic) typically 6–12 weeks later if fit for surgery.

Complications (Low Overall)

Bile leak, catheter dislodgement, hemorrhage, bowel injury, tract bleeding. Mortality <1% procedure-related; most deaths reflect underlying critical illness.

Key point: PC is not curative for calculous disease—stones persist. It buys time for optimization or provides palliation. Multidisciplinary decision (surgery, IR, ICU) is essential.