2 The condition, current treatments and procedure
2.1 Acute calculous cholecystitis is inflammation of the gallbladder caused by a gallstone or biliary sludge that blocks the cystic duct. The blockage in the cystic duct causes bile to build up in the gallbladder, increasing the pressure inside it and causing it to become inflamed. Symptoms include pain, fever, nausea and vomiting.
2.2 Treatments include intravenous fluids, medicines (analgesics and antibiotics), endoscopic or percutaneous biliary drainage, and surgery (laparoscopic or open cholecystectomy). NICE's guideline on gallstone disease recommends offering early laparoscopic cholecystectomy (to be carried out within 1 week of diagnosis) to patients with acute cholecystitis.
2.3 This procedure places a stent via a cholecystostomy tract into the cystic duct to provide antegrade gallbladder drainage and prevent further obstructive episodes of cholecystitis. This procedure is suitable for patients who otherwise need long-term external drainage.
2.4 Before the procedure, a percutaneous cholecystostomy and drainage is done to resolve the acute episode. This procedure is usually done using conscious sedation. The cholecystostomy drain is used for cholangiography to confirm cystic duct obstruction. Under fluoroscopic guidance, a guidewire and catheter are passed through the cholecystostomy tract, through the cystic duct and into the duodenum. A stent is then inserted and placed in or across the cystic duct.
2.5 After the procedure, an external gallbladder drain is usually left in situ for a few days to ensure that there is good antegrade drainage of bile into the duodenum. The external drain can then be removed after a satisfactory cholangiogram.