Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Cholecystostomy, Percutaneous (also known as Percutaneous Gallbladder Drainage or Percutaneous Cholecystostomy)
Summary
A percutaneous cholecystostomy is a minimally invasive procedure used to drain an infected or inflamed gallbladder. It involves the insertion of a catheter into the gallbladder through the skin, guided by imaging techniques such as ultrasound or CT scan. The procedure helps alleviate the symptoms of gallbladder infection and inflammation.
Purpose
This procedure is performed to manage acute cholecystitis (infection and inflammation of the gallbladder), especially in patients who are not good candidates for immediate surgery. The goal is to relieve symptoms, reduce infection, and improve overall patient health, potentially as a bridge to later surgical intervention.
Indications
- Acute cholecystitis not manageable with antibiotics alone
- Patients with high surgical risk due to underlying conditions
- Critically ill patients who may not tolerate surgery
Preparation
- Fasting for at least 6 hours before the procedure.
- Adjustment of medications as advised by the healthcare provider.
- Blood tests to check coagulation status.
- Imaging studies to plan the procedure.
Procedure Description
- The patient is positioned appropriately (usually lying down).
- Local anesthesia is administered to numb the area.
- Imaging guidance (ultrasound or CT scan) is used to locate the gallbladder.
- A needle is inserted through the skin and guided into the gallbladder.
- A catheter is passed over the needle and into the gallbladder to drain the contents.
- A cholecystogram may be performed to visualize the gallbladder and bile ducts.
- The catheter is secured in place to allow continuous drainage.
- Radiological supervision and interpretation are involved throughout the process to ensure accuracy.
Duration
The procedure typically takes about 30 minutes to an hour.
Setting
Percutaneous cholecystostomy is typically performed in a hospital's interventional radiology suite.
Personnel
- Interventional radiologist
- Radiologic technologist
- Nurse
- Anesthesiologist (if sedation is required)
Risks and Complications
- Infection at the catheter insertion site
- Bleeding
- Injury to nearby organs
- Dislodgment or blockage of the catheter
- Allergic reactions to contrast dye (if used)
Benefits
- Rapid relief of symptoms due to gallbladder infection and inflammation
- Avoidance of immediate surgery in high-risk patients
- Potential stabilization of the patient for future surgical treatment
Recovery
- Monitoring in a hospital setting for a few hours post-procedure.
- Instructions on catheter care and signs of complications.
- Follow-up appointments to assess recovery and plan further treatment.
- Typical recovery time can vary, with some patients needing the catheter for several weeks.
Alternatives
- Intravenous antibiotics alone (for mild cases)
- Laparoscopic cholecystectomy (surgical removal of the gallbladder)
- Open cholecystectomy (required in complex cases)
Patient Experience
- The patient might feel pressure or mild discomfort during catheter insertion.
- Post-procedure, there may be some pain or tenderness at the catheter site, manageable with medication.
- Continuous drainage from the catheter can cause discomfort, but it effectively reduces symptoms of the gallbladder condition.