Gallbladder drainage and cystic duct stenting

Author(s): Dr Rehan Abdul-Halim, Dr Frederick Lee

Hospital: Sheffield Teaching Hospitals

Reference: RAD Magazine, 42, 498, 13-15

Excerpt: 

Acute cholecystitis (AC) is one of the commonest presentations to the surgical ward in developed countries. Clinical features, blood analysis and imaging usually lead to an early diagnosis and prompt initiation of antibiotic and supportive medical therapy. Although the clinical course is often self-limiting, complications related to gallbladder perforation, fistulae formation and disseminated sepsis can occur. The current management guideline for AC is cholecystectomy during the acute admission where possible, typically within 72 hours.

In those with a delayed presentation many surgeons advocate postponing the operation for six weeks which reduces the complexity of the procedure related to adhesions. Similarly those patients who are acutely decompensated secondary to the sepsis may go on to have a delayed cholecystectomy; these patients can be stabilised with medical therapy with or without an external gallbladder drain. There is a further cohort of usually elderly patients who, because of co-morbidities, will never be able to undergo a cholecystectomy. These patients present a challenge as they are at risk of recurrent episodes of AC, particularly if gallstones are present. Long-term internal or external drainage of the gallbladder is a possible management plan for this growing subgroup of patients.

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