A cholecystostomy is a medical procedure that creates an opening into the gallbladder, typically for drainage. It is often performed when the gallbladder becomes inflamed or infected. While surgical removal (cholecystectomy) is a common treatment, a cholecystostomy offers an alternative. This article explains the procedure, its purpose, tube management, and recovery.
What is a Cholecystostomy and Why is it Performed?
A cholecystostomy involves placing a catheter, or thin tube, into the gallbladder to drain bile and other fluids, most commonly performed through the skin as percutaneous cholecystostomy. The gallbladder stores bile, which aids digestion. When bile flow is obstructed, often by gallstones, or when the gallbladder becomes inflamed, it leads to acute cholecystitis, causing pain, pressure, and infection.
The procedure primarily treats acute cholecystitis in patients unsuitable for immediate gallbladder removal surgery. This includes critically ill, clinically unstable individuals, or those with severe health conditions making general anesthesia or major surgery unsafe. It is also considered for patients who have not responded to initial medical treatment. Draining the gallbladder helps relieve pressure, reduce inflammation, and manage infection, stabilizing the patient’s condition.
A cholecystostomy is typically a temporary measure, bridging to a more definitive treatment like a cholecystectomy once the patient’s health improves. For some high-risk individuals, especially those with acute acalculous cholecystitis (inflammation without gallstones), drainage may be the definitive treatment. This less invasive option addresses the acute issue, avoiding higher risks of emergency surgery in compromised patients.
The Cholecystostomy Procedure
The cholecystostomy procedure is minimally invasive and typically performed by an interventional radiologist. Patient preparation involves intravenous fluids, antibiotics, and often a sedative. The procedure usually takes 30 minutes to an hour.
Imaging techniques like ultrasound or fluoroscopy (a type of live X-ray) guide catheter placement. Ultrasound is often preferred for real-time guidance and portability, allowing bedside procedures. The chosen skin area, usually on the right abdomen, is cleaned with a sterile solution, and local anesthesia numbs the insertion site. Sterile drapes maintain a clean environment, minimizing infection risk.
A small needle is guided through the skin into the gallbladder using imaging. Once positioned, a thin catheter is inserted to drain bile and fluids into an external collection bag. The catheter is then secured to the skin with a stitch or adhesive dressing to prevent dislodgement, and the insertion site is covered with a sterile dressing.
Managing the Cholecystostomy Tube
Patients and caregivers must understand how to manage a cholecystostomy tube at home to ensure its function and prevent complications. The tube remains in place for several weeks, typically four to six, allowing the tract from skin to gallbladder to mature. During this time, it continuously drains fluid into a collection bag.
Daily care involves regular dressing changes and cleaning the insertion site. Dressings should be changed every three days, or sooner if soiled or wet. When changing, gently clean the skin around the tube with soap and water. A fresh gauze pad is then placed over the site and secured with a transparent film dressing or tape if skin sensitivity is an issue.
Monitoring drainage output is important. Patients or caregivers should regularly empty, measure, and record the fluid collected in the drainage bag. The tube may require daily flushing with normal saline to maintain patency, as instructed by the healthcare team. Proper securing of the tube to the body, often with specialized adhesive devices, helps prevent accidental pulling or dislodgement.
Potential Considerations and Recovery
While generally safe and effective, certain considerations and potential issues can arise. Complications occur in approximately 10% of cases, with catheter dislodgement, blockage, or bile leakage being common. Less frequent but more serious complications include infection at the insertion site, significant bleeding, or, rarely, injury to nearby organs. Patients should be aware of problem signs: increased pain, redness, swelling, foul-smelling drainage around the tube site, or fever.
The cholecystostomy tube typically remains in place for several weeks, allowing acute inflammation to resolve and the patient’s condition to stabilize. Once inflammation subsides and the patient is stable, the tube may be removed. Before removal, a healthcare provider may perform an imaging study through the tube to confirm bile duct patency and ensure no leakage.
For many patients, especially those with gallstones, cholecystostomy is a temporary measure. Definitive treatment involves a cholecystectomy, or surgical removal of the gallbladder. This subsequent surgery is usually performed as an elective procedure once the patient has recovered from the acute episode and is fit for surgery. In some cases, particularly for poor surgical candidates, the cholecystostomy tube may be a long-term or permanent solution.