November 14th 2015
I wish to provide some experience as a fourth-year medical student in regards to the recent article published in your journal, Cholecystostomy – an obsolete or relevant treatment? For the benefit of other readers of your journal, I seek to lend support to the points outlined in the article through examination of one particular case, and to use the experience of this encounter to demonstrate first-hand the effectiveness of percutaneous cholecystostomy in patients unable to undergo surgery.
My patient was admitted to the surgical department for acute right upper quadrant pain, without jaundice, and a diagnosis of severe cholecystitis complicated by empyema was promptly made. There were no visible stones upon ultrasound or plain abdominal radiograph. Following extensive testing of his pulmonary and cardiovascular functions, and taking in to consideration his numerous comorbidities including advanced age of 76 years, type II diabetes, and COPD, the patient was deemed ineligible for surgery and was treated with percutaneous cholecystostomy and oral antibiotics. After several days, he recovered and was discharged only to return one week later with recurrent symptoms. Due to reasonable suspicion of choledocholithiasis, given this recurrence, ERCP was conducted which revealed two stones located in the common bile duct. Sphincterotomy and extraction of the biliary calculi were performed without complication along with a second cholecystostomy and the patient was once again started on oral antibiotics. As of the time of this writing, the patient is recovering well with no signs of complication.
I believe the effectiveness of cholecystostomy in patients for whom surgery is contraindicated is well demonstrated by this case, which lends support to your recent article. Hopefully my experience serves to illustrate this for other interested readers and medical professionals.
Medical Student Charles University,
Second Faculty of Medicine
150 00 Praha 5