Cholecystostomy, the formation of a stoma between the abdominal wall and the gallbladder, is indicated in the elderly, infirm patient with an empyema or mucocoele in whom dissection around the biliary tree would be difficult acutely. On the intensive care unit, percutaneous cholecystostomy can be used to rule out the gallbladder as a source of sepsis.
If present, stones are removed from the inside of the gallbladder at laparotomy. A fine catheter or cholangiogram is used to confirm that a conduit exists between the gallbladder and common bile duct. A large Foley catheter is fixed into the gallbladder with a purse-string, and the fundus of the gallbladder is sutured to the parietal peritoneum where the catheter passes through the bladder wall.
A cholangiogram is performed at seven days and the catheter is removed at ten days. If no stones are left once the catheter is removed, then the gallbladder often fibroses and gives no more problems. If stones are still present, they can be extracted using a choledochoscope along the catheter track.
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