Percutaneous cholecystostomy for management of acute cholecystitis in severely ill patients

Aim: In this study, we aimed to determine the therapeutic efficacy of percutaneous cholecystostomy (PC) in critically ill patients with an APACHE II score greater than or equal to 12 in the management of acute cholecystitis (AC) compared to conservative treatment. Material and Methods: Clinical data from January 2007 to June 2020 of 132 and 125 patients managed by PC and conservative treatment, respectively, were retrospectively analyzed. Medical records of patient demographics, comorbidities, indications for PC catheter placement, complications, alterations in laboratory parameters (white blood cell (WBC) count, C-reactive protein (CRP) value) and APACHE II scores, and clinical outcomes during follow-up were retrieved from our hospital database for this case-control study. Results: After PC, a statistically significant decrease in WBC counts, CRP values and APACHE 11 scores was found in the study group compared to the control group (p <0.022). Additionally, the admission to follow-up ratio of WBC counts, CRP values and APACHE II scores was significantly higher in the study group than in the control group (p <0.001). Following PC, WBC counts, CRP values and APACHE 11 scores decreased significantly over time (p <0.001). After the PC procedure, catheter indwelling time ranged from 1 to 45 days. Except for one patient who died within a few hours following intervention, no major complications related to PC were observed. Out of 132 patients, 29 minor complications were noted. Discussion: In critically ill, high-risk patients, PC compared to conservative treatment was found to be a safe and efficient salvage therapy for the management of AC.