Published: 2019-12-26

Comparison of the role of ultrasound guided transhepatic aspiration of gallbladder versus conservative management of acute calculous cholecystitis

Vivek Ramesh Udupi, Sushanto Neogi, Anju Garg


Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.

Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.

Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.

Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone. 


Ultrasound guided aspiration, Acute cholecystitis, Leucocytosis, Pain, Duration of stay

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Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Textbook of surgery. Stomach. 19th ed. Philadelphia: Elsevier; 2012: 1495.

Pessaux P, Regenet N, Tuech JJ, Rouge C, Bergamaschi R, Arnaud JP. Laparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 2001;11:252-5.

Gde CD, Dertkigil SS, Baracat J. Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients. Sao Paulo Med J. 2003;121:260-2.

Bingener J, Richards ML, Schwesinger WH, Strodel WE, Sirinek KR. Laparoscopic cholecystectomy for elderly patients: gold standard for golden years?. Arch Surg. 2003;138:531-5.

Chopra S, Mumbower AL, Chintapalli KN, Sweisinger WH, Dorman JP. Treatment of acute cholecystitis in non-critically ill patients at high surgical risk; comparison of clinical outcomes after gall bladder aspiration and after percutaneous cholecystostomy. AJR 2001;176;1025-31.

Sartelli M, Abu Zidan FM, Catena F, Griffith EA, Di Saverios S, Coimbra R, et al. Abdominal sepsis. World J Emerg Surg. 2015;10:6.

National Institutes of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy. Am J Surg. 1993;165:390-8.

Riall TS, Zhang D, Townsend CM, Kuo YF, Goodwin JS. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg 2010; 210: 668-79.

Dunham F, Marliere P, Mortier C, Gulbis A. Ultrasound-guided percutaneous and transhepatic cholecystostomy: a complementary procedure to therapeutic endoscopy. Endoscopy. 1985;17:153–6.

Eggermont A, Lameris J, Jeekel J. US-guided percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis. Arch Surg. 1985;120:1354-6.

Van Sonnenberg E, Wing VW, Pollard JW, Casola G. Life-threatening vagal reactions associated with percutaneous cholecystostomy. J Radiol. 1984;151:377-80.

Tseng LJ, Tsai CC, Mo LR, Lin RC, Kuo JY, Chang KK, et al. Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastro-enterology. 2000;47:932-6.

Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Sekimoto M, et al. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg. 2007;14:1-10.

Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

Teckchandani N, Garg PK, Hadke NS, Jain SK, Kant R, Mandal AK, et al. Predictive factors for successful early laparoscopic cholecystectomy in acute cholecystitis: a prospective study. Int J Surg. 2010;8:623-7.

Ahmad F, Islahi S, Hingora OM, Singh Y. Cholelithiasis–a clinical and microbiological analysis. Int J Sci Stud. 2014;2:40-5.

Tazawa J, Sanada K, Maekawa S, Sakai Y, Yamane M, Kusano F, et al. Gallbladder aspiration for acute cholecystitis in high-surgical-risk patients. J Gastroenterol Hepatol. 2003;18:463-5.

Tsutsui K, Uchida N, Hirabayashi S, Kamada H, Ono M, Ogawa M, et al. Usefulness of single and repetitive percutaneous transhepatic gallbladder aspiration for the treatment of acute cholecystitis. J Gastroenterol. 2007;42(7):583-8.

Verbanck JJ, Demol JW, Ghillebert GL, Rutgeerts LJ, Surmont IP. Ultrasound-guided puncture of the gallbladder for acute cholecystitis. Lancet. 1993;341:1132-3.

Johansson M. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastro Surg. 2003;7:642.

Macafee DA, Humes DJ, Bouliotis G, Beckingham IJ, Whynes DK, Lobo DN. Prospective randomized trial using cost–utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg. 2009;96:1031-40.

Johansson M. Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003;7:642.