Cholecystoduodenal Stenting: An Option in Complicated Acute Calculous Cholecystitis in the Elderly Comorbid Patient

Abstract

We describe the course of an 84-year-old lady with acute calculous cholecystitis. She was unable to have a cholecystectomy due to multiple comorbidities including morbid obesity, type 2 diabetes, Guillain–Barrè syndrome, chronic sacral pressure ulcer, and severe cardiac disease. Conservative treatment with intravenous antibiotics was initially successful; however, she subsequently re-presented with an empyema of the gallbladder. She was readmitted for further intravenous antibiotics and underwent percutaneous gallbladder drainage. The patient did not want a permanent catheter for drainage, nor the prospect of repeat drainage procedures in the future for recurrent cholecystitis. Following a discussion of the rationale and risks involved with other minimally invasive techniques, she underwent cholecystoduodenal stent placement following disimpaction and removal of cystic duct stones. The procedure restored antegrade gallbladder drainage, and at 18 months she remains symptom-free from her gallbladder. Long-term management of recurrent cholecystitis in elderly comorbid patients commonly includes permanent cholecystostomy or repeated percutaneous gallbladder drainage, both of which can be poorly tolerated. Permanent cholecystoduodenal stenting is a reasonable alternative in carefully considered patients in whom the benefits outweigh the risks. We describe our experience with cholecystoduodenal stenting and discuss some of the concerns and considerations with this technique.

Cystic duct disimpaction for acute cholecystitis in the high-risk cholecystectomy patient: Case report

“…A case report by Bonner et al describes cystic duct disimpaction with cholecystoduodenal stenting for a high-risk patient with AC. 10 Brown et al also described resolution of cholecystitis with metallic stent placement into the cystic duct in five patients. 11 Stent placement into the cystic duct is a technically challenging procedure.…”

“…Additionally, biliary stents can migrate and cause perforation, leading to further complications. 10 A study of 33 patients by Hersey et al found a 91% technical success rate and 10% 30-day complication rate among patients undergoing cystic duct stenting for cholecystitis. 12 In our patient, stenting was deferred due to patient’s anatomy.…”

Acute Pancreatitis following Percutaneous Electrohydraulic Lithotripsy

“…However, there is a lack of reliable prospective evidence to support the effectiveness of this procedure. 2 In addition, prolonged external drainage via a cholecystostomy tube has been linked to a reduced quality of life and may give rise to complications like tube dislodgement, infections, pain, and the development of fistulas. 3…”

“…However, there is a lack of reliable prospective evidence to support the effectiveness of this procedure. 2 In addition, prolonged external drainage via a cholecystostomy tube has been linked to a reduced quality of life and may give rise to complications like tube dislodgement, infections, pain, and the development of fistulas. 3 Interventional radiology presents an alternative option for patients by performing percutaneous electrohydraulic lithotripsy and insertion of cholecystoduodenal stents with the aid of endoscopy.…”

Percutaneous cholecystoduodenal stent as a definite treatment for acute cholecystitis in elderly or comorbid patients: a bicentric retrospective study

“…Only one previous clinical study of 33 patients and several case reports have been published on percutaneous CDS placement; thus, this topic requires more extensive clinical studies. 2 , 5 , 6 , 7 , 8 , 9 Furthermore, no dedicated devices are available for this procedure, and the most appropriate type of stent is unknown. Additionally, recent literature on endoscopic CDS supports the efficacy of CDS.…”