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Research Paper | General Surgery | India | Volume 12 Issue 3, March 2023 | Rating: 4.9 / 10
Laparoscopic Cholecystostomy in Emphysematous Cholecystitis a Fulminant Variety in Difficult Case- A Race against Time
Anant Kumar | Harsha MP
Abstract: Introduction: This study was conducted to evaluate role of laparoscopic cholecystectomy in difficult case. Gallstone is a very common disease condition and affects 10-20% of the adults in the developed countries and 20% of the patients present with acute calculous cholecystitis. One of the severe complications is emphysematous cholecystitis, which can occur in as 1%-3% of patients with acute cholecystitis which was first reported by Stoltz in 1901, and perforation of gallbladder (GB) in 1%. Emphysematous cholecystitisa fulminant variety of acute cholecystitis is defined as gas in the lumen of the GB wall as a result of ischemia following progressive vascular insufficiency, and infection with gas forming bacteria such as clostridium perfringens, klebsiella and is a severe complication of cholelithiasis. Which can be rapidly fatal. Factors such as male sex, advanced age, delay in seeking treatment, cardiovascular diseases, and diabetes mellitus increase the likelihood of developing cholecystitis and carry a significantly higher mortality rate between 15% and 50%. Hence, making early diagnosis and immediate intervention are required in these cases is emergent cholecystectomy. In severely ill patient, percutaneous cholecystectomy with broad-spectrum antibiotics may be an alternate choice. Safer treatment modalities such as laparoscopic cholecystostomy help the patient to recover from the critical illness and the definitive procedure can be performed at a later, safer period. Case description: Ten patients with emphysematous cholecystitis, i.e., Three females and seven male, underwent laparoscopic cholecystostomy. All the patients recovered well, and no complication like feature suggestive of sepsis and peritonitis was reported during or after the procedure and were discharged after a stay of 5-7 days. All the patients underwent elective laparoscopic cholecystectomy and are doing well at 3 and 6-months follow-up. Conclusion: Cholecystectomy in fulminant variety of emphysematous cholecystitis carries high risk of morbidity and mortality. In this setting, laparoscopic cholecystostomy is a safe and reliable procedure to recover the patient from the serious complication and proceed with elective laparoscopic cholecystectomy.
Keywords: Emphysematous cholecystitis, Interval cholecystectomy, Laparoscopic cholecystostomy
Edition: Volume 12 Issue 3, March 2023,
Pages: 1661 - 1664