Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis

Management of NSAID-Induced Penetrating Gastric Ulcer Complicated by Hemorrhagic Cholecystitis: The Role of Percutaneous Transhepatic Biliary Drainage

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic and anti-inflammatory effects but can lead to serious gastrointes complications. This report illustrates the management of an NSAID-induced penetrating gastric ulcer with subsequent postoperative hemorrhagic cholecystitis. A 68-year-old female with chronic NSAID use presented with epigastric pain and was diagnosed with a penetrating gastric ulcer extending into the retroperitoneum. The surgical management required a shift from a minimally invasive robotic-assisted approach to an open procedure due to unexpected intraoperative findings. The postoperative period was notable for the development of hemorrhagic cholecystitis that was managed with percutaneous transhepatic biliary drainage, highlighting the role of interventional radiology in complex postoperative care. NSAID use significantly increases gastrointestinal risks, leading to complications such as ulcers that may penetrate into adjacent structures, including the retroperitoneum. The management of penetrating gastric ulcers typically involves complex surgical procedures, highlighted in this scenario by the necessity for an antrectomy followed by a Billroth II reconstruction to address the extensive damage and restore gastrointestinal continuity, which is essential for patient recovery. In this case, the development of hemorrhagic cholecystitis postoperatively was effectively managed with a percutaneous transhepatic biliary drain, demonstrating the importance of interventional radiology in managing postoperative complications and the need for a multidisciplinary approach. This case report elucidates the management of NSAID-induced penetrating gastric ulcer that extended into the retroperitoneum, necessitating an antrectomy with Billroth II reconstruction. A gastric ulcer is generally classified as "large" if it exceeds 2 centimeters in diameter. These ulcers pose greater risks of complications such as perforation, penetration into adjacent organs, bleeding, and obstruction, necessitating more complex and comprehensive management strategies. The postoperative complication of hemorrhagic cholecystitis was effectively managed via interventional radiology, highlighting the critical role of minimally invasive techniques in addressing severe postoperative complications.

Percutaneous Cholecystostomy is a Feasible and Safe Option for High-Risk Acute Cholecystitis Patients

Objective: The best option for treating high-risk patients with acute cholecystitis is still being determined. We evaluated our high-risk acute cholecystitis patients in whom we preferred percutaneous cholecystostomy and aimed to determine whether this approach was safe and feasible. Methods: We retrospectively reviewed our 71 patients in whom we performed percutaneous cholecystostomy between May 2019 and July 2023. All procedures were performed with local anaesthesia under ultrasonographic guidance via the transhepatic route. The catheters were removed when the signs of acute cholecystitis were significantly regressed or when the catheters were found to be ineffective. The catheters of those eligible for surgery were removed during the operations. Results: All procedures were successful without failure, and no significant complications developed in the post-intervention period. Pain at the catheter insertion site (20 patients) was the leading minor complication, and in one patient, bilioma was detected and percutaneously drained. The procedure was ineffective in 7 patients (9.85%), and the catheters were removed. In 22 patients (31%), interval cholecystectomy surgery was performed. In the subgroup of patients whose catheters were adequate and were not operated (5 patients), the catheters were removed after an average of 27.2 days. The mean length of stay was 9.6 days, and four patients died (5.6%) during the index hospitalization. Conclusion: Our findings suggest that percutaneous cholecystostomy is a feasible, safe and highly effective treatment option for acute cholecystitis in high-risk patients.