Pericholecystic abscess: classification of US findings to determine the proper therapy.

Abstract

Sixteen patients with a pericholecystic abscess were classified into three groups according to the sonographic findings: Nine patients had an abscess in the gallbladder bed, three in an intramural location in the gallbladder, and four in an intraperitoneal cavity. In the gallbladder bed group, six patients with a localized abscess responded well to conservative therapy, followed by an elective operation. Two patients with a complicated abscess were initially treated with ultrasonically (US) guided percutaneous transhepatic gallbladder drainage and then with percutaneous transhepatic aspiration of the liver abscess, followed by an elective operation. A patient with a communicating abscess underwent an elective operation because the abscess completely disappeared after percutaneous transhepatic abscess drainage under US guidance. One of the three patients with an intramural abscess needed an immediate operation, and the other two were treated conservatively, followed by an elective operation. All four patients with an intraperitoneal abscess needed an emergency operation. Because each type of abscess received differing and successful treatments, the authors' method of classification of US findings seemed to provide a useful way to select the specific therapeutic procedure to achieve optimal results.

Current management of gall bladder perforations

“…The three patients, in whom preoperative identification was not possible, probably had milder pathology and responded to antibiotic therapy without any increase in mortality or morbidity. The results of ultrasound and computerized tomography in our patients are similar to those quoted in various studies comparing efficacy of ultrasound and CECT in detecting gall bladder perforation 12,16,17 . It is essentially those patients in whom early identification alters the course of treatment who will be benefited by these investigations thereby improving the outcomes.…”

Sonographic diagnosis of gallbladder perforation.

“…7 The second sign is direct demonstration using color Doppler imaging of flow between the lumen of the gallbladder and a pericholecystic abscess across a gallbladder wall defect. 8 This sign was demonstrated in our case as the flow of bile through a large defect in the gallbladder wall. The third sign is the detection of calculi within the perihepatic collection, indicating that gallbladder rupture has occurred.…”

Synchronous pyogenic liver abscess and acute cholecystitis: how to recognize it and what to do (emergency cholecystostomy followed by delayed laparoscopic cholecystectomy)

“…CS is traditionally performed in patients affected by AC but unfit for cholecystectomy [37], and has recently been proposed also in fit patients [32]. During an AC episode, the location of the gallbladder, which is usually distended by infected bile/pus, normally allows for a US-guided [25] or CT scan-guided [37] CS. Results are good, allowing for the treatment of AC and avoiding general anesthesia and emergency surgery in most cases.…”

“…Whereas AC is approached surgically in most cases, the treatment of PLA is a matter of debate. Modern antibiotic therapy and recently developed tools/ techniques offer a wide variety of treatment options for PLA, ranging from conservative management [24][25][26] to mini-invasive approaches (percutaneous drainage, laparoscopy) [4,24,25] to traditional surgery [24,27,28]. There are no guidelines that clearly indicate the ideal management of patients with synchronous AC and PLA.…”