Cholecystostomy

Cholecystostomy is a procedure that creates a drainage route from the gallbladder, typically to the exterior, to relieve biliary obstruction or infection. The most common form is percutaneous cholecystostomy, in which a catheter is placed into the gallbladder under image guidance (ultrasound or CT) and is externalized to allow bile drainage. The procedure is usually performed with local anesthesia and sedation, and broad-spectrum antibiotics are often given around the time of placement.

Indications for cholecystostomy include acute cholecystitis in patients who are high-risk for immediate cholecystectomy, severe gallbladder distension with infection or empyema, gallbladder perforation, or biliary obstruction when decompression is needed and surgical options are not feasible. It can also serve as a temporizing measure in patients with severe pancreatitis or other comorbidities.

In many cases, cholecystostomy serves as a bridge to definitive treatment, with interval cholecystectomy or formal biliary surgery considered once the patient’s condition improves. Alternatives to external drainage include internal drainage techniques such as cholecystoduodenostomy or cholecystojejunostomy, though these are less commonly used.

Complications can include bleeding, bile leak, catheter dislodgement, infection, and bile peritonitis. Successful outcomes depend on appropriate patient selection, catheter management, and timely follow-up to determine whether definitive gallbladder surgery is feasible.