The Effect of Cholecystostomy Upon Subsequent Roentgenologic Appearance of the Gallbladder

Thirty-Five, twenty-five, and even twenty years ago a considerable number of physicians and surgeons regarded cholecystostomy as preferable to cholecystectomy for chronic disease of the gallbladder. Inasmuch as present criteria for either operation differ considerably from those held previously (due to the availability of antibiotics and the development of improved anesthetic and operative procedures, as well as the fact that patients now avail themselves of medical care earlier), it is believed that there will be few opportunities in the future to study any appreciable number of patients in whom cholecystostomy has been followed, after a significant period of time, by cholecystography. Material And Methods This study presents the results of cholecystography in a series of 38 patients who had previously undergone cholecystostomy. In almost all instances, the operation had been performed originally for acute cholecystitis or empyema of the gallbladder. In none of these cases was it done as an elective or interval procedure. Thirty-four of the 38 patients were females; 4 were males. In 28 instances, gallstones were present at the time of cholecystostomy. Drainage of the gallbladder was continued up to six weeks postoperatively, the average time being ten days. Cholecystograms were obtained from four months to forty-three years after operation, the average interval being 15.6 years. Cholecystography was performed in the usual manner and in almost all instances Priodax was the contrast agent. Where the gallbladder was not visualized, the examination was repeated. In only 7 cases were cholecystograms taken prior to the cholecystostomy available for comparative studies. Results Normal cholecystograms were obtained in only 11 of the 38 individuals (29 per cent) who were examined radiologically following cholecystostomy. In 10 additional patients a normal concentration of the gallbladder medium was present in the viscus but calculi could be clearly demonstrated. In 17 persons visualization of the gallbladder was not obtained, and in 6 of these radiopaque calculi were seen. No correlation was noted between the results of cholecystography and the interval between that examination and cholecystostomy or the age or sex of the patient. Since 27 of the 38 patients (71 per cent) examined had evidence of disturbed gallbladder function, it may be concluded that the performance of cholecystostomy, for relief of acute inflammation of the gallbladder, in the hope that drainage of the viscus will result in a return to normal function, is not justified. Of the 28 patients in whom gallstones were present at the time of cholecystostomy, 8 had a normal cholecystogram. In the remaining 20 (71 per cent), evidence of disturbed gallbladder function was observed. In 6 of the latter group there was good visualization and calculi were demonstrated.