Laparoscopic Cholecystostomy in Gangrenous Cholecystitis with Localized Peritonitis

JOURNAL TITLE: The Journal of Medical Sciences

Author
1. RV Ramanakumar
2. Abhinav Balaji
3. Midhun M John
4. P Balaji
ISSN
2321-354X
DOI
10.5005/jp-journals-10045-00128
Volume
5
Issue
3
Publishing Year
2019
Pages
2
Author Affiliations
1. com.mps.common.model.Contributor@6f32c83f ,
2. com.mps.common.model.Contributor@1b64a7b8 ,
3. com.mps.common.model.Contributor@2bae752a ,
4. com.mps.common.model.Contributor@354ed411
Article keywords
Gangrenous cholecystitis, Interval cholecystectomy, Laparoscopic cholecystostomy

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.

© 2019 Jaypee Brothers Medical Publishers (P) LTD.   |   All Rights Reserved

Powered by MPS ScholarStor