All the World Is a Nail. Why Are Surgeons Resistant to Learn How to Place Cholecystostomy Drains in Seriously Ill Patients With Acute Acalculous Cholecystitis?

The American Surgeon
Jay Requarth

Abstract

Surgeons routinely provide palliative care, but often the technical procedure needed for the palliative intervention is beyond our training and comfort zone. This case is an example of surgical palliative care that utilizes image-guided techniques to provide optimal care. A frail elderly patient with multiple comorbidities who had been hospitalized for other diseases was diagnosed with acute acalculous cholecystitis. General surgery and gastroenterology were initially consulted, and the patient was referred to interventional radiology for a percutaneous cholecystostomy. The procedure was technically successful, and the patient's clinical status improved. A few days later, a follow-up cholecystogram showed a decompressed gallbladder, patent cystic duct, a common bile duct free of stones, and dilute contrast in the duodenum. After 2 weeks, the fistula tract was interrogated and found to be intact. The cholecystostomy tube was removed without incident. This case is presented as a call to action for surgeons to learn the skills required to place percutaneous cholecystostomies themselves and to add it to their surgical armamentarium.

References

Mar 1, 1985·The British Journal of Surgery·P W HoughtonL A Donaldson
Aug 1, 1994·AJR. American Journal of Roentgenology·G W BolandP R Mueller
Jul 17, 2003·Current Gastroenterology Reports·Philip S Barie, Soumitra R Eachempati
Sep 11, 2009·International Archives of Medicine·Shaheen E LakhanYaacov Leiter
Mar 24, 2010·Journal of Vascular and Interventional Radiology : JVIR·Wael E A SaadJohn F Cardella
Jan 25, 2011·AJR. American Journal of Roentgenology·Heath K McCulloughJay A Requarth
Apr 2, 2014·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Enver Zerem, Safet Omerović
Jan 9, 2015·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·J KirkegårdF V Mortensen
Sep 16, 2015·Journal of Vascular and Interventional Radiology : JVIR·Jay A Requarth
Oct 28, 2015·Journal of Vascular and Interventional Radiology : JVIR·Jay A Requarth
Jan 11, 2017·Journal of the American College of Surgeons·Francesca M DimouTaylor S Riall

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