Percutaneous cholecystoduodenostomy: a case report.

Abbreviations: PC percutaneous cholecystostomy, PCD percutaneous conversion cholecystoduodenostomy TREATMENT of acute cholecystitis via cholecystectomy, in patients who have associated debilitating conditions, is associated with high mortality and morbidity rates, reaching 30% and 55%, respectively, for open surgical procedures (1), although a laparoscopic approach may reduce the risks (2). Therefore, percutaneous cholecystostomy (PC) as a safe, minimally invasive procedure remains a commonly accepted method of treatment of acute cholecystitis in patients who have contraindications to surgery (3). Percutaneous cholecystostomy could be curative in many, but not all, such high-risk cases (4). When PC fails to resolve cholecystitis, the patient may be cured by a subsequent surgical cholecystectomy, if the risk for surgery is reduced (5,6). However, in a few cases, when contraindications for surgical procedures persist, the patients may be bound to have protracted external drainage until the purulent discharge ceases and the signs of cholecystitis resolve. Such a period may last up to 7 months (7) or longer. The presence of a catheter draining purulent material into a bag imposes serious restrictions to the patient. The system requires constant care, such as irrigation, cleaning, and dressing of the insertion site, emptying the bag, and periodic catheter changes. In addition, the outside catheter and bag limit the physical activity of the patient. Such catheters could be inadvertently removed, which poses an unnecessary risk and may require urgent intervention. We present a case in which the disadvantages of external drainage after PC were eliminated by a percutaneous conversion to a cholecystoduodenostomy (PCD). CASE REPORTS