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- acute cholecystitis
- cirrhotic patients
- laparoscopic cholecystectomy
- percutaneous gall bladder aspiration
Cholelithiasis is a common disease in patients with cirrhosis due to intravascular haemolysis and functional alterations of the gall bladder.1 Acute cholecystitis (AC) results from obstruction of the cystic duct, usually by a gall stone, followed by distension and subsequent chemical or bacterial inflammation of the gall bladder. Approximately 95% of people with AC have gall stones (calcolous cholecystitis) and 5% lack gall stones (acalcolous cholecystitis). Severe AC may lead to necrosis of the gall bladder wall and to perforation, more commonly in patients with chronic diseases such as diabetes mellitus, renal failure, or cirrhosis.2 Early cholecystectomy is the standard treatment for AC in the general population and laparoscopic cholecystectomy (LC) is generally a safe and effective procedure even in cases of acute inflammation of the gall bladder.3,4 Although there is increasing evidence that patients with early cirrhosis may undergo LC with low morbidity and no mortality even when presenting with AC, patients with advanced cirrhosis are at high risk for surgery.3,4 Those with AC who have multiple comorbid conditions and relative contraindications for surgery may be treated conservatively with antibiotics and drip infusion and, more recently, by radiological interventional procedures in order to decompress the gall bladder and to interrupt the pathogenic mechanism of cystic duct obstruction, distension, and infection of the bile which may lead to gangrenous cholecystitis.5,6
Gall bladder decompression by a sonografically guided percutaneous cholecystostomy was firstly reported by Radder in 1980 for gall bladder empyema and later on several studies confirmed the safety and …
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