Techniques et indications de la cholécystostomie percutanée dans la prise en charge de la cholécystite aiguë en 2014

The gold standard in treatment of acute cholecystitis is cholecystectomy associated with antibiotics. In certain circumstances, percutaneous cholecystostomy is an interventional alternative. Percutaneous cholecystostomy is usually performed under local anesthesia by the radiologist using ultrasonographic or CT guidance. A drain can be inserted either through a transhepatic or a transperitoneal approach. Complications occur in nearly 10% of cases including hemorrhage, hemobilia, pneumothorax or bile leaks, depending on whether the approach was transhepatic or transperitoneal. The main indications for percutaneous cholecystostomy are resistance to medical treatment or severely ill patients in intensive care. Drains should be maintained three to six weeks before removal. In patients with good general condition (ASA score I-II), secondary cholecystectomy can be recommended to avoid recurrence.