Cholecystostomy

What is a cholecystostomy?

A cholecystostomy is a minor procedure that creates an opening into your gallbladder. “Cholecyst-” means gallbladder, and “-ostomy” means a surgically created opening. Your gallbladder is a small, hollow organ that stores bile for your digestive system. A healthcare provider might have to create an opening in your gallbladder to treat a gallbladder disease like infection, inflammation or gallstones.

What is a percutaneous cholecystostomy?

The most common type of cholecystostomy is a procedure to place a catheter in your gallbladder. A catheter is a long tube that leads from inside your body to the outside. Sometimes a catheter has to go through your skin to get to the outside. This is what “percutaneous” means. A percutaneous cholecystostomy creates an opening in your gallbladder and in your skin for a catheter to go through.

Why would I need a cholecystostomy?

Most of the time, a cholecystostomy is a drainage procedure. Healthcare providers place a catheter (tube) through a percutaneous cholecystostomy to drain fluid from your gallbladder and relieve pressure, pain and, often, infection. This is an alternative treatment for people with gallbladder diseases who are too sick or aren’t good candidates to have surgery to remove their gallbladder.

What medical conditions does a cholecystostomy treat?

A percutaneous cholecystostomy is a treatment for acute gallbladder inflammation (cholecystitis). Inflammation is a reaction from your immune system that causes swelling with bodily fluids. It’s often a reaction to a bacterial infection. You might have an infection in your gallbladder if your bile flow has stalled, causing bacteria to accumulate. This is often due to a gallstone blocking one of your bile ducts.

What’s the difference between a cholecystostomy and cholecystectomy?

A cholecystectomy, which sounds similar, is a surgical operation to remove your gallbladder (“-ectomy” means removal). This is another potential treatment for acute cholecystitis. In fact, cholecystectomy is the more common treatment for gallbladder disease because it’s definitive, meaning it solves your gallbladder issues for good. A cholecystostomy is an alternative treatment that offers temporary relief.

Why would you have a cholecystostomy vs. cholecystectomy?

Healthcare providers recommend cholecystectomy for most people with gallbladder issues, because these issues tend to repeat. You can live well without a gallbladder. But some people aren’t in good condition for this operation when they arrive seeking treatment. A percutaneous cholecystostomy is a much less invasive procedure that can help relieve your symptoms while you’re recovering from illness.

When is a cholecystostomy done?

A cholecystostomy often happens under urgent circumstances. Cholecystitis can continue to worsen without treatment and, in severe cases, can be life-threatening. If you’re having a cholecystostomy instead of a cholecystectomy, you likely have additional health concerns or complications that would’ve made the larger operation unsafe for you. These might add to the urgency of your treatment.

Who performs a cholecystostomy?

In most cases, an interventional radiologist performs a percutaneous cholecystostomy. An interventional radiologist uses imaging technology — like ultrasound, X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging) — to guide minor procedures. They can make the small cuts necessary to remove tissue samples or place medical tools, like a catheter, in your body. They’ll often consult with a general surgeon in the planning stage of the operation.

What is the preparation for a cholecystostomy?

Before your cholecystostomy, your healthcare team will:

• Make sure you understand the risks and benefits, and why they recommend it. They’ll ask you to sign your informed consent.
• Recommend that you don’t eat or drink for a few hours before the procedure.
• Test your blood clotting ability and treat it if necessary to reduce your risk of bleeding. Possible treatments to improve blood clotting include transfusions and vitamin K.
• Install a small tube into your vein to deliver IV fluids, antibiotics and sedation, if you wish.

What happens during the cholecystostomy procedure?

During the procedure, your healthcare team will:

• Monitor your vital signs and give you supplemental oxygen through a face mask if you need it.
• Clean and sterilize the skin on your abdomen and inject local anesthesia to numb the area. It might sting a bit when the needle goes in.
• Use ultrasound or CT imaging to determine the best route for the cholecystostomy tube to pass through. This will depend on how your organs are arranged and any related health factors.
• Use X-ray imaging to guide the cholecystostomy tube into your gallbladder with a needle and guidewire. They’ll remove the needle and guidewire once the tube is in place.
• Secure the catheter to your skin with a stitch and connect the end to a drainage bag.
• Decompress your gallbladder and/or remove gallstones as needed.

What are the different routes for cholecystostomy tube placement?

There are two ways that the catheter can get to your gallbladder through your abdomen. It can go through your peritoneum, a membrane that covers your gallbladder, or through your liver, which sits on top of your gallbladder. These routes have different pros and cons, depending on your anatomy and related health conditions. Your healthcare provider will weigh these factors to decide the best route.

The two types of operations are called:

1. Percutaneous transperitoneal cholecystostomy.
2. Percutaneous transhepatic cholecystostomy.

How long does a cholecystostomy last?

The procedure for cholecystostomy tube placement may take 30 minutes to an hour, depending on your condition and the challenges involved. The cholecystostomy tube will remain in place for several weeks after that — usually four to six. The tube will continuously drain fluids from your gallbladder into your drainage bag. Your healthcare team will instruct you on caring for your cholecystostomy drain at home.

What’s involved in cholecystostomy tube care?

Cholecystostomy drain care includes wound care, flushing the tube and emptying the bag daily.

• Wound care: You’ll need to keep your wound dressing clean and dry. Don’t immerse it in the bath and use a plastic covering when you shower. Change the dressing daily, cleaning up any fluid secretions around the tube. If the tube loosens from your skin, secure it with tape and contact your provider.
• Tube flushing: Your healthcare team will instruct you on how to flush your tube each day. This helps to prevent blockages and bacterial infections. You’ll disconnect the tube from the drainage bag and inject the flush into the tube with a syringe. The flush is about 5 to 10 cc of sterile saline solution.
• Bag emptying: While your tube is disconnected from your bag, you can empty the bag into the toilet by removing the cap and turning it upside down. Your healthcare provider might ask you to record your bile output before disposing of it. They’ll want to know if your output suddenly increases or decreases.

What happens before the cholecystostomy drain is removed?

Before removing the drain, your healthcare provider will want to make sure your gallbladder is done draining and your symptoms have resolved. One way is by clamping your tube for 24 to 48 hours to see if this causes any symptoms. Another common procedure is to take a cholangiogram, imaging of your biliary tract, to make sure your bile is flowing without obstruction before removing the tube.

What are the advantages of cholecystostomy for acute cholecystitis?

Cholecystostomy is a minimally invasive alternative to cholecystectomy that can be equally effective in the short term. It has an excellent safety profile, even among critically ill and older people, and a 95% success rate in resolving acute cholecystitis. It can serve as a bridge to later cholecystectomy, or as a definitive treatment. If necessary, the drain can stay in place long-term to prevent further issues.

What are the possible risks or side effects of cholecystostomy?

Complications from the procedure are rare and mostly minor. Possible complications include:

• Excessive bleeding.
• Bile leakage.
• Septicemia.

Possible tube complications following the procedure include:

• Tube blockage.
• Tube dislodgement.
• Tube infection.

How soon after treatment will I feel better?

As drainage relieves pressure and reduces infection in your gallbladder, you should feel better very soon. You may still need to stay in the hospital a little longer, until your overall condition improves. Most people show measurable improvement in three to four days. Once you’re better, your healthcare provider will discuss with you whether they recommend further treatment, like a cholecystectomy.

When should I contact my healthcare provider during my recovery?

Contact your healthcare provider if you develop or notice:

• A fever over 101 degrees Fahrenheit (38.3 degrees Celsius).
• Unexplained abdominal pain or pain at the tube site.
• Redness, irritation or smelly discharge at the tube site.
• Your tube won’t flush.
• Your tube detaches from your skin.
• Bile leaks from your tube.
• Bile output suddenly increases.
• Bile output suddenly stops.

A note from Cleveland Clinic

There are a handful of reasons why a surgeon might need to create an ostomy, an opening, in one of your organs. Placing a catheter is one common reason. When your gallbladder needs drainage through a catheter, it’s usually under dire circumstances. Your gallbladder may be swollen and inflamed, blocked, infected or all of these. A cholecystostomy is a minor intervention that can de-escalate your condition.