Interventional radiology in the gallbladder: diagnosis, drainage, dissolution, and management of stones

Article Abstract:

The gallbladder is a small sac-like organ located near the liver that stores bile secreted by the liver. It is subject to a number of diseases and abnormalities such as over-accumulation of bile and gallstones. Until recently, diagnosis of gallbladder diseases was limited to percutaneous transhepatic cholangiography (PTC), X-rays obtained by passing a scope through the bile ducts, and treatment was limited to surgery. PTC is often unsuccessful because the ducts are too narrow or are blocked. X-rays are now often obtained by directly puncturing the gallbladder with a needle rather than trying to enter the gallbladder through the bile ducts. Direct puncture of the gallbladder is also used to obtain fluid or tissue (biopsy) samples which can be examined for infection and disease. New treatments have also been developed that are less drastic than surgery. Cholecystectomy, surgical removal of the gallbladder, is the standard treatment for some gallbladder diseases, but it poses great risks to certain patients. The gallbladders in these patients can now be drained by percutaneous cholecystostomy (PC), which involves placing a catheter into the inflamed area. PC can also be used to treat obstructive jaundice and gallbladder abscesses. PC is also useful for removing gallstones nonsurgically. The stones can be directly removed through the catheter with forceps or they can be dissolved or broken up using lasers or chemicals directed through the catheter. Complications can result from using PC, however. Bile can leak from the area surrounding the catheter. The cardiovascular system may be affected with resulting hypotension (low blood pressure) or bradycardia (slow heart rate). Procedures for diagnosing and treating gallbladder diseases are rapidly improving and promise to be safer and more effective while being less intrusive. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cholecystitis, editorial

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The benefits of percutaneous cholecystostomy for decompression of selected cases of obstructive jaundice

Article Abstract:

Jaundice is a disease caused by abnormally large amounts of bile entering the blood. This is sometimes the result of an obstruction in the bile-carrying vessels of the gallbladder, causing the bile to distend the gallbladder. The standard procedure for draining the gallbladder is called transhepatic percutaneous biliary drainage (PBD), which involves reaching the blockage through the bile ducts found in the liver. The blockage usually causes the bile ducts to dilate (open wider) which assists the PBD, but sometimes no dilation occurs and PBD is very difficult to perform. A new technique, percutaneous cholecystostomy (PC), which involves making a fistula, or opening, in the vessel or gallbladder to allow drainage, has been studied as an alternative to PBD when dilation does not occur. It has not gained wide acceptance because of its limited use, but this study examines the advantages and benefits of this technique for simplifying drainage. The use of PC to treat 11 patients with obstructions in the gallbladder that were causing jaundice was studied. All PCs were successfully performed, allowing for temporary drainage. The procedures were all performed quickly and easily. No major side effects and only a few minor side effects occurred. Although the relief was only temporary, it allowed patients to recover enough to be prepared for later, more extensive treatment. These results show that PC can be a useful treatment in certain patients. PBD is the first choice of treatment because it offers long-term relief, but in some patients, PBD may either be difficult or dangerous to perform initially, and thus PC offers an easier and safer method of temporary relief until PBD or another procedure can be safely performed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Surgery, Cholestasis, Cholecystectomy, Gallbladder, Biliary tract, Jaundice, Obstructive

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Gallbladder perforation and bile leakage: percutaneous treatment

Article Abstract:

Surgical removal of the gallbladder (cholecystectomy) is often the treatment for severe gallbladder disease. It can be a risky procedure in elderly or very ill patients. A new treatment, percutaneous cholecystostomy (PC), has recently been developed for use in some patients with gallbladder disease. PC uses a catheter to drain fluid from the gallbladder for temporary relief until surgery or other treatment can be performed or until the gallbladder heals. This study examined the use of PC to treat patients with a perforation (abnormal hole) in their gallbladders accompanied by bile leakage. Four patients were studied, three with gallstones that caused perforations in the gallbladders and one with bile peritonitis (inflammation of peritoneum, the membrane lining the abdominal cavity, caused by bile) due to a leak in the gallbladder. The patients were either at high risk of complications from surgical removal of their gallbladders or they refused to have this procedure. Patients were treated with PC along with antibiotics and other supportive measures. The results showed that no major complications occurred. Long-term follow-up found the patients to be well and symptom-free, excluding one patient who had surgery to remove the gallbladder one month after PC. The results showed PC to be effective in draining the gallbladder and allowing it to heal. Further research needs to be performed to establish its long-term benefits, but PC appears to be a valuable short-term treatment for patients who cannot or refuse to undergo surgery to remove the gallbladder. (Consumer Summary produced by Reliance Medical Information, Inc.)

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