Korean J Gastroenterol.  2015 Jun;65(6):370-374. 10.4166/kjg.2015.65.6.370.

Bedside Endoscopic Ultrasound-guided Transgastric Gallbladder Aspiration and Lavage in a High-risk Surgical Case Due to Acute Cholecystitis Accompanied by Multiorgan Failure

• Yun SH
• Park MS
• Lee JU
• Yang MA
• Han SH
• Lee YJ
• Jeong GM
• Cho YK
• Kim JW
• Cho JW

• KMID: 2373240
• DOI: http://doi.org/10.4166/kjg.2015.65.6.370

Abstract

Cholangitis and cholecystitis are intra-abdominal infections that show poor prognosis upon progression to sepsis and multiorgan failure. Administration of antibiotics with high antimicrobial susceptibility and removal of infected bile at the initial treatment are important. After undergoing ERCP for diagnostic purposes, a 58-year-old man developed acute cholangitis and cholecystitis accompanied by rhabdomyolysis, multi-organ failure, and severe sepsis. Broad-spectrum antibiotics with bedside endoscopic nasobiliary drainage were administered, but clinical symptoms did not improve. Therefore, bedside EUS-guided transgastric gallbladder aspiration and lavage was performed, resulting in successful treatment of the patient. We report the above described case along with a discussion of relevant literature.

Keyword

Sepsis; Rhabdomyolysis; Cholangitis; Cholecystitis; Endosonography

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholecystitis, Acute/complications/*diagnosis/diagnostic imaging
Drainage
Duodenoscopy
Endosonography
Escherichia coli/isolation & purification
Humans
Male
Middle Aged
Multiple Organ Failure/pathology
Rhabdomyolysis/complications/diagnosis
Sepsis/diagnosis/etiology/microbiology
Therapeutic Irrigation
Tomography, X-Ray Computed

Figure

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  Fig. 1. (A) MRCP; normal bile duct and pancreatic duct. (B) Duodenoscopic finding (TJF 260V; Olympus, Tokyo, Japan); a bulging ampulla of vater. (C) ERCP; no definitive distal common bile duct filling defect by balloon catheter with iopamidol enhancement. (D) Plain abdominal radio-graphy; complete contrast enhancement in the gallbladder and bile duct two days after ERCP.

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  Fig. 2. (A) The gallbladder and common bile duct showing complete enhancement with surrounding fluid collection on the hepatobiliary CT scan 3 days after ERCP. (B) Adherence of an inflamed gallbladder wall to adjacent stomach on the CT scan 3 days after ERCP. (C) EUS; the gallbladder and stomach walls attached because of the inflammation and internal heterogenous echogenicity with irregular thickened gallbladder wall. (D) EUS-guided transgastric gallbladder aspiration and lavage using a 19-gauge needle (G52012, ECHO- HD-19-A; Cook Medical, Limerick, Ireland).

Reference

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