A cholecystostomy is a medical procedure that establishes a temporary pathway for drainage from the gallbladder to the outside of the body. This is achieved by placing a catheter directly into the gallbladder, usually through the skin of the abdomen, which is known as a percutaneous cholecystostomy. The primary goal is to decompress the gallbladder, relieve pressure, and drain infected fluid or bile. It serves as a less invasive alternative to immediate surgical removal when a patient is too ill to tolerate a major operation.
Why a Cholecystostomy is Necessary
The procedure is typically required to manage acute cholecystitis, which is sudden and severe inflammation of the gallbladder. When the flow of bile is blocked, often by gallstones, the resulting fluid buildup causes the organ to swell, leading to pain and a high risk of bacterial infection. Immediate surgical removal of the gallbladder, called a cholecystectomy, is the standard treatment, but it involves general anesthesia and significant physiological stress.
Drainage is chosen over immediate surgery for patients considered high-risk or unstable due to existing severe co-morbidities. Conditions affecting the heart, lungs, or kidneys can make the risks associated with general anesthesia too high to proceed with an emergency operation. The cholecystostomy stabilizes the patient by rapidly reducing the infection and inflammation, effectively buying time until their overall condition improves.
Cholecystitis is categorized as either calculous (caused by gallstones blocking the cystic duct) or acalculous (inflammation without the presence of stones). Acalculous cholecystitis often affects critically ill patients in intensive care settings, perhaps due to severe trauma, burns, or prolonged fasting. By draining the infected contents, the procedure helps to control sepsis and allows antibiotic therapy to work more effectively.
How the Procedure is Performed
The cholecystostomy is a minimally invasive procedure, most often performed by an interventional radiologist in a specialized suite. The patient is usually given local anesthesia to numb the insertion site, and sometimes a light sedative is administered to ensure comfort. The use of anesthesia and sedation allows the patient to remain conscious and breathe on their own, which is safer for those with compromised health.
To ensure accuracy, the radiologist uses real-time imaging guidance, such as ultrasound or a CT scan, to visualize the gallbladder and surrounding structures. This imaging allows the physician to map the safest path to the gallbladder, avoiding nearby organs like the colon or stomach. A small incision is then made in the skin, and a thin needle is guided into the gallbladder lumen under continuous imaging control.
Once the needle is correctly positioned, a guidewire is advanced through it, and the needle is removed. The tract is then gently dilated to the appropriate size to allow the final drainage catheter to be passed over the wire and secured inside the gallbladder. The catheter is often a pigtail-style drain, which has a curled tip to help anchor it in place. The external portion of the tube is secured to the skin with a suture or specialized fixation device and connected to a collection bag to monitor the drainage of bile and infected material.
Living with and Removing the Drainage Tube
Caring for the cholecystostomy tube requires diligent attention to the tube and the insertion site during recovery. Patients or their caregivers must monitor the drainage bag, noting the volume and appearance of the fluid. The drainage typically transitions from thick, infected material to clearer bile as the inflammation subsides. The skin around the insertion site requires regular cleaning and dressing changes to prevent local infection.
Potential minor complications include the tube becoming blocked, which can reduce drainage effectiveness, or accidental dislodgement, which requires immediate medical attention for replacement. A bile leak around the tube is also possible, which can irritate the skin. Patients are taught to recognize signs of infection, such as increased pain, redness, or fever, and to watch for changes in the drainage.
The drainage tube is intended to be a temporary measure, remaining in place for several weeks until the acute infection has fully resolved and the patient’s condition has stabilized. Before the tube is removed, a contrast study is often performed, where a dye is injected into the tube to confirm that the bile duct system is open and that the newly formed tract has matured. Once clinical improvement is confirmed and the patient is strong enough to tolerate surgery, the tube can be withdrawn in an outpatient setting, often paving the way for a definitive cholecystectomy.