Radiologie interventionnelle des voies biliaires

Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014

“…Two approaches have been described: trans-hepatic and trans-peritoneal. The trans-hepatic route is used preferentially by most authors because it reduces the risk of biliary leak, allows the drain to be left in place for longer periods and leads to quicker maturation of a drainage tract [7,9].…”

“…The trans-peritoneal route can be used when the transhepatic route is impossible for anatomical reasons, or in case of liver disease or coagulation disorders, as long as the gallbladder is distended, and abuts the abdominal wall [7,9].…”

“…2). Two techniques have been described for percutaneous cholecystostomy [7,9]. The Seldinger technique consists of inserting a fine needle into the gallbladder under local anesthesia.…”

“…Several complications are possible during these maneuvers including vasovagal syncope, particularly when the puncture is performed under local anesthesia [7]. Moreover, the incidence of more severe complications is approximately [12], and bile leak for the transperitoneal route, which can lead to biliary peritonitis, especially when bile is infected [9].…”

“…Drain dependency seems to facilitate bile flow [7]. While negative pressure does not seem to be necessary, conversely, rinsing the drain with 10 mL of saline daily or twice daily should suffice to avoid obstruction.…”