Indications

• Gall bladder (GB) decompression in the setting of calculous or acalculous cholecystitis

  • • Temporary as a bridge to surgery or recovery

    • Permanent in non-surgical candidates (calculous)

• PTC access when transhepatic not possible

Contraindications

• Uncorrectable coagulopathy (high risk procedure for bleeding)

• Porcelain GB (or extensive stones) may limit ability to form pigtail

• GB tumor (procedure may result in tumor seeding)

Imaging Review

• Confirm that imaging findings diagnose cholecystitis (definitive US or CT with good clinical hx) or…

• HIDA (Cholescintigraphy) showing nonvisualization of GB after 3-4 hours or 30 min after morphine administration

Tips for Workup

• Reverse anticoagulation if possible. Those who cannot be reversed require a high-level discussion about risks of hemorrhage vs benefit of the procedure.

• Consent: Hemorrhage, bowel injury, bile peritonitis, biloma pneumothorax / effusion, infection.