Gall bladder decompression for cholangitis: bridge to a definitive procedure
Abstract
Introduction and Aim: Cholangitis requires
obstruction of the biliary tree with superadded infection of
the biliary system. Obstruction could be due to stone
disease, stricture in the bile duct and growth involving the
biliary system. Apart from the medical resuscitation,
immediate decompression of the biliary system is also
needed in patients with severe cholangitis. We present our
experience with emergency biliary decompression through
the gall bladder. Materials and methods: We analysed
our case records retrospectively from Jan 2014 to May
2017, and identified three patients who underwent
emergency gall bladder decompression for cholangitis and
analysed their clinical presentation, response to treatment
and clinical outcome. Results: All three patients had grade
III cholangitis with varied etiologies. The reasons for
performing gallbladder decompression was because of
severe cholangitis and failed endotherapy or unavailability
of percutaneous/ ERCP guided therapy in the emergency
setting. All the patients underwent Ultrasound guided
percutaneous catheter drainage under local anaesthesia.
Outcome of these patients depends upon the primary
pathology, co-morbidity, performance status. Conclusion:
When endoscopic or percutaneous techniques are either
unavailable or have failed, Gall baldder decompression
can achieve successful biliary decompression and should
be kept in mind to salvage the patient in difficult situations.
Full Text:
PDFReferences
H. Shimada, G. Nakagawara, and M. Kobayashi,
“Pathogenesis and clinical features of acute cholangitis
accompanied by shock,” Japanese Journal of Surgery, vol. 14,
no. 4, pp. 269–277, 1984.
B. M. Reynolds and E. L. Dargan, “Acute obstructive
cholangitis; a distinct clinical syndrome,” Annals of Surgery,
vol. 150, no. 2, pp. 299–303, 1959.
Sato, Kent T. “Percutaneous Management of Biliary
Emergencies.” Seminars in Interventional Radiology 23.3
(2006): 249–257. PMC. Web. 25 June 2017.
Takada, T., Kawarada, Y., Nimura, Y., Yoshida, M.,
Mayumi, T., Sekimoto, et al. Background: Tokyo Guidelines
for the management of acute cholangitis and
cholecystitis. Journal of Hepato-Biliary-Pancreatic Surgery
(2007), 14(1), 1–10.
Boland G W, Lee M J, Leung J, Mueller P R.
Percutaneous cholecystostomy in critically ill patients: early
response and final outcome in 82 patients. AJR Am J
Roentgenol. 1994;163:339–342.
Kim K H, Sung C K, Park B K, Kim W K, Oh C W, Kim K
S. Percutaneous gallbladder drainage for delayed
laparoscopic cholecystectomy in patients with acute
cholecystitis. Am J Surg. 2000;179:111–113.
Shirai Y, Tsukada K, Kawaguchi H, Ohtani T, Muto T,
Hatakeyama K. Percutaneous transhepaticcholecystostomy
for acute acalculouscholecystitis. Br J Surg. 1993;80:
–1442.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
An Initiative of The Tamil Nadu Dr MGR Medical University