Can you imagine the unbearable pain caused by a severe infection, inflammation, or gallstones in your gallbladder? Sometimes, in such a case, the patient’s condition can be so serious that surgery to completely remove the gallbladder is not possible. In such cases, we will talk about a special, less invasive treatment method that doctors use to save the patient’s life, reduce pain, and control the infection.
What is a cholecystostomy?
Simply put, a cholecystostomy is a minor medical procedure where a small hole is made in your gallbladder and a tube (catheter) is inserted through it. As the name suggests, "cholecyst-" means gallbladder, and "-ostomy" means surgically created opening. The gallbladder is a small sac-like organ that stores bile, which is needed for our digestive system.
This method is often called a "percutaneous cholecystostomy." "Percutaneous" means something done through the skin. That means the doctor makes a small hole through the skin of your abdomen and inserts this tube into the gallbladder.
The main goal of this treatment is to remove the infected fluid (bile and pus) that has accumulated inside the gallbladder, reduce internal pressure, and control pain and infection.
Why is this kind of treatment necessary?
This treatment is often needed in a condition called acute cholecystitis. This occurs when something like gallstones blocks a bile duct, causing bile to pool and become infected with bacteria. This causes the gallbladder to swell and become very painful.
Usually, the best treatment for this condition is a surgery to completely remove the gallbladder (cholecystectomy). However, if the patient suffers from other serious diseases such as heart disease, diabetes, kidney disease, or is very old, he may not be able to withstand a major surgery at that time. In such cases, as an alternative to major surgery, this treatment called Cholecystostomy is done to stabilize the patient's condition.
What is the difference between Cholecystostomy and Cholecystectomy?
These two names may be a bit similar, so you might get confused. But these are two different treatments. Let's clearly understand the difference between the two.
| Characteristic | Cholecystostomy (tube placement) | Cholecystectomy (surgical removal) |
|---|---|---|
| Nature of treatment | A temporary solution. Something done to control symptoms. | Permanent solution. The gallbladder is completely removed. |
| Aggression | It's small. It only makes a small hole. | Too much. Major surgery (open or laparoscopic). |
| Usage cases | For those who are seriously ill and cannot withstand major surgery. | Many patients who are in good health can undergo surgery. |
| Result | A drain tube is placed to drain the fluid from the gallbladder. | Gallbladder is removed from the body. |
How is this treatment performed?
This is usually done by an Interventional Radiologist . That is, a specialist who uses imaging technology such as ultrasound and CT scan to look at the organs inside the body and make very precise small incisions to perform treatment.
Preparation before treatment
- The doctor will explain the risks and benefits of this treatment to you and obtain your informed consent.
- You are advised to refrain from eating or drinking for a few hours.
- A blood test is done to check the blood's ability to clot. If necessary, treatment is given.
- An IV line will be placed in a vein in your arm to give you antibiotics, saline, and, if necessary, sedation.
What happens during treatment
1. Your heart rate and blood pressure are constantly monitored.
2. The area where the stomach tube will be inserted is cleaned and a numbing medicine is injected.
3. Ultrasound or CT scan will be used to determine the best and safest route to insert the tube (this route may be through the liver (transhepatic) or through the abdominal wall (transperitoneal).
4. Then, under X-ray guidance, the tube is inserted into the gallbladder using a very fine needle and a guidewire.
5. Once the tube is in place, it is secured to the skin with a suture , and the other end of the tube is connected to a drainage bag.
This entire process can usually take between 30 minutes and an hour.
How do you take care of the tube after treatment?
This is the most important part. This drain tube will usually stay in your body for 4 to 6 weeks . You will need to take good care of it when you go home.
- Wound care: The dressing on the tube should be changed daily. Keep the area clean and dry. Wear a waterproof plastic cover when bathing.
- Tube flushing: To prevent bile from getting stuck in the tube, you need to flush the tube with sterile saline about once a day. Your doctor or nurse will show you how to do this.
- Bag emptying: The bag that collects fluid should be emptied as soon as it fills up. Your doctor may also tell you to keep track of how much fluid you are collecting each day. If the fluid suddenly increases or stops coming out, that is an important sign.
Before the tube is removed, a special X-ray test called a cholangiogram is performed to see if the bile flow in the gallbladder is now normal and there is no blockage anywhere. Only after it is confirmed that everything is fine is the tube removed.
What are the benefits and risks of this treatment?
On the plus side, this is a very safe and effective treatment. The success rate in controlling acute cholecystitis is as high as 95%. It can provide a quick recovery with very low risk for a patient who is unable to tolerate major surgery.
Risks and complications are rare, but we should be aware of them.
| Type of complication | Possible things |
|---|---|
| Things that may occur during treatment | Excessive bleeding, bile leakage into the abdominal cavity, and accumulation of germs in the blood (septicemia). |
| What can happen later with the pipe? | Tube blockage, tube dislodgement, infection around the tube. |
When should I call the doctor?
If you experience any of the following symptoms during your recovery, immediately notify your doctor or the hospital where you received treatment.
- Fever: A fever greater than 38.3 Celsius (101 Fahrenheit).
- Pain: Severe, unexplained pain in the abdomen or where the tube was inserted.
- Signs of infection: redness of the skin around the tube, swelling, or a foul-smelling discharge.
- Tube problems: inability to flush the tube, tube coming out of the skin, bile leaking out of the tube.
- Change in fluid volume: A sudden increase or complete cessation of the amount of fluid added to the bag.
In such a situation, it is very important to seek medical advice immediately.
Take-Home Message
- Cholecystostomy is a minimally invasive, safe treatment for patients with acute gallbladder inflammation who are not candidates for surgery.
- This involves inserting a tube through the skin into the gallbladder and removing the infected fluid.
- This tube will need to be left in the body for several weeks, and it is very important to care for it properly at home.
- After this treatment, when the patient's condition improves, the doctor will decide whether a gallbladder removal surgery (cholecystectomy) is necessary.
- If you experience any unusual symptoms during your recovery, notify your doctor immediately.
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