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Radiology.Academy.Sk

IR Percutaneous Cholecystostomy

History/Indication for procedure: 72-year-old man with acute cholecystitis and complex medical history making him a poor surgical candidate. Please perform percutaneous cholecystostomy.
Procedure: Ultrasound and fluoroscopically guided percutaneous cholecystostomy tube placement.
Physicians:
Complications: None.
Medications:
1. 1% lidocaine local.
2. 1 mg Versed IV.
3. 50 mcg fentanyl IV.
Contrast: 20 mL Omnipaque 300 nonionic contrast intra cholecystic.
EBL: Less than 2ml
Operative note and findings:
The patient was counseled as to the risks, benefits, and alternatives to the
procedure, and opted to proceed. Oral and written consent were obtained. The
patient was placed supine on the interventional radiology table. Sedation was
administered, the patient's state of consciousness and vital signs were
monitored throughout the entire procedure, and sedation was discontinued at the
conclusion of the procedure by the sedation nurse.

The patient's distended gallbladder as well as and appropriate subhepatic access
tract was evaluated using ultrasound. The access site was anesthetized using 1%
lidocaine. Under ultrasound guidance, the gallbladder was punctured using an
21-gauge AccuStick access needle. Approximately 40 ml of nonpurulent but heavily
sedimented bile was drained. Non-foul smelling. Samples of this bile were sent
for culture. A 0.018 inch wire was then advanced and seen within the gallbladder
fluoroscopically. A cholecystogram was performed, showing a uniformly dilated
gallbladder without visualization of the cystic duct. A 0.035 inch Amplatz wire
was advanced coaxially within the gall bladder alongside the 0.018" wire.

The 0.018 inch wire was maintained as a safety wire. Under fluoroscopic
guidance, an 8 French 30 centimeter Navarre drainage catheter was advanced to
the level the gallbladder fossa. The cope loop was formed and locked.
Postplacement cholecystogram confirmed intra cholecystic positioning. An
additional 60 mL of bile was then aspirated from the gallbladder and discarded.
The catheter was then secured with percutaneous sutures as well as a hemostatic
dressing. The catheter was left to gravity drainage.

The patient tolerated the procedure well, and was transferred back to the
recovery unit in good condition. There were no complications.

Impression: Status post technically successful percutaneous cholecystostomy.

Plan:
1. Flush tube TID with 10ml sterile water or saline.
2. If tube removal is desired, tube cannot be removed sooner than 6 weeks in
addition to tract evaluation under fluoroscopy to ensure tract durability.