Acute Perforated Cholecystitis Complicated by Peri-cholecystic Collection Treated with Endoscopic Ultrasound-Guided Gallbladder Drainage

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is generally contraindicated in cases of acute perforated cholecystitis due to the risk of peritoneal dissemination of gastric or intestinal contents. An 80-year-old morbidly obese woman with severe comorbidities presented to the emergency department with fever and abdominal pain. A CT scan revealed findings consistent with acute calculous cholecystitis complicated by gallbladder perforation and a peri-cholecystic collection. The patient was considered unfit for surgery; therefore, she underwent percutaneous drainage with the placement of a tube in both the gallbladder and the peri-cholecystic collection. After four weeks, the patient's condition worsened with persistent drainage of purulent material from the cholecystostomy. A trans-papillary drainage of the gallbladder through ERCP failed due to impacted stones in the cystic duct. Subsequent percutaneous cholecystography demonstrated no contrast medium extravasation from the collection into the abdominal cavity. Given this, the collection tube was removed, and EUS-guided transduodenal placement of a lumen-apposing metal stent was performed, followed by prompt clinical improvement. The following day, the cholecystostomy tube was removed, and the patient remained asymptomatic. Conclusions: In specific cases where patients are too fragile to undergo cholecystectomy, EUS-GBD may be considered for treating perforated cholecystitis following percutaneous drainage, which allows for collection maturation.

Publication History

Article published online:
27 March 2025