The Journal of Medical Sciences

Register      Login

VOLUME 5 , ISSUE 3 ( July-September, 2019 ) > List of Articles

CASE REPORT

Laparoscopic Cholecystostomy in Gangrenous Cholecystitis with Localized Peritonitis

P Balaji, Abhinav Balaji, RV Ramanakumar, Midhun M John

Keywords : Interval cholecystectomy, Laparoscopic cholecystostomy,Gangrenous cholecystitis

Citation Information : Balaji P, Balaji A, Ramanakumar R, John MM. Laparoscopic Cholecystostomy in Gangrenous Cholecystitis with Localized Peritonitis. J Med Sci 2019; 5 (3):77-79.

DOI: 10.5005/jp-journals-10045-00128

License: CC BY-NC 4.0

Published Online: 00-09-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Gallstone is a very common disease condition and affects 10–20% of the adults in the developed countries and 20% of the patients present with acute calculous cholecystitis.1 One of the severe complications is gangrenous cholecystitis, which can occur in as high as 40%2,3 of patients with acute cholecystitis, and perforation of gallbladder (GB) in 2–18%.4 Gangrenous cholecystitis is defined as necrosis and perforation of the GB wall as a result of ischemia following progressive vascular insufficiency and is a severe complication of cholelithiasis. Factors such as male sex, advanced age, delay in seeking treatment, leukocytosis, cardiovascular diseases, and diabetes mellitus increase the likelihood of developing gangrenous cholecystitis and carry a significantly higher mortality rate between 15% and 50%.5 Hence, early diagnosis and immediate intervention are required in these cases. Laparoscopic cholecystectomy for gangrenous cholecystitis carries a high risk of morbidity and mortality. Hence, safer treatment modalities such as laparoscopic cholecystostomy help the patient to recover from the critical illness and the definitive procedure can be performed at a later, safer period. Case description: Six patients with gangrenous cholecystitis, i.e., five females and one male, underwent laparoscopic cholecystostomy. All the patients recovered from sepsis, and no complication was reported during or after the procedure and were discharged after a stay of 5–7 days. All the patients underwent elective laparoscopic cholecystectomy after 10–12 weeks and are doing well at 1-year follow-up. Conclusion: Cholecystectomy in gangrenous cholecystitis carries high risk of morbidity and mortality. In this setting, laparoscopic cholecystostomy is a safe and reliable procedure to recover the patient from the acute sepsis and proceed with elective laparoscopic cholecystectomy at a later date.


PDF Share
  1. Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002;325(7365): 639–643. DOI: 10.1136/bmj.325.7365.639.
  2. Fagan SP, Awad SS, Rahwan K, et al. Prognostic factors for the development of gangrenous cholecystitis. Am J Surg 2003;186(5): 481–485. DOI: 10.1016/j.amjsurg.2003.08.001.
  3. Aydin C, Altaca G, Berber I, et al. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepatobiliary Pancreat Surg 2006;13(2):155–159. DOI: 10.1007/s00534-005-1042-8.
  4. Roslyn J, Busuttil RW. Perforation of the gallbladder: a frequently mismanaged condition. Am J Surg 1979;137(3):307–312. DOI: 10.1016/0002-9610(79)90056-4.
  5. Habib FA, Kolachalam RB, Khilnani R, et al. Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis. Am J Surg 2001;181(1):71–75. DOI: 10.1016/S0002-9610(00)00525-0.
  6. Niemeier OW. Acute free perforation of the gall-bladder. Ann Surg 1934;99(6):922. DOI: 10.1097/00000658-193499060-00005.
  7. Glenn F. Acute cholecystitis. Surg Gynecol Obstet 1976;143(1):56–60.
  8. Bedirli A, Sakrak O, Sözüer EM, et al. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology 2001;48(41):1275–1278.
  9. Parker LJ, Vukov LF, Wollan PC. Emergency department evaluation of geriatric patients with acute cholecystitis. Acad Emerg Med 1997;4(1):51–55. DOI: 10.1111/j.1553-2712.1997.tb03643.x.
  10. Tanaka M, Takahashi H, Yajima Y, et al. Idiopathic perforation of the gallbladder: report of a case and a review of the Japanese literature. Surg Today 1997;27(4):360–363. DOI: 10.1007/BF00941814.
  11. Sood BP, Kalra N, Gupta S, et al. Role of sonography in the diagnosis of gallbladder perforation. J Clin Ultrasound 2002;30(5):270–274. DOI: 10.1002/jcu.10071.
  12. Menakuru SR, Kaman L, Behera A, et al. Current management of gallbladder perforations. ANZ J Surg 2004;74(10):843–846. DOI: 10.1111/j.1445-1433.2004.03186.x.
  13. Wang AJ, Wang TE, Lin CC, et al. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterology 2003;9(12):2821. DOI: 10.3748/wjg.v9.i12.2821.
  14. Van Sonnenberg E, D'Agostino H, Casola G. Interventional gallbladder procedures. Radiol Clin North Am 1990;28(6):1185.
  15. Ong CL, Wong TH, Rauff A. Acute gall bladder perforation—a dilemma in early diagnosis. Gut 1991;32(8):956–958. DOI: 10.1136/gut.32.8.956.
  16. Chowbey PK, Venkatasubramanian R, Bagchi N, et al. Laparoscopic cholecystostomy is a safe and effective alternative in critically ill patients with acute cholecystitis: two cases. J Laparoendosc Adv Surg Tech A 2007;17(1):43–46. DOI: 10.1089/lap.2006.05078.
  17. Cuschieri A, Berci G. Laparoscopic cholecystolithotomy and cholecystostomy. In: Laparoscopic Biliary Surgery. Oxford: Blackwell Scientific; 1992. pp. 148–154.
  18. Cuschieri A. Cholecystostomy drainage for severe acute cholecystitis. In: Operative Manual of Endoscopic Surgery. Berlin, Heidelberg: Springer; 1992. pp. 240–245.
  19. Nandyala VN, Chintakindi SB, Pallagani L, et al. Gall bladder perforation-is it still a diagnostic dilemma: a retrospective study. Int Surg J 2016;3(2):609–613. DOI: 10.18203/2349-2902.isj20161131.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.