|
|
COMMENTS |
|
|
|
| Year : 2006 | Volume
: 22
| Issue : 1 | Page : 79 |
| |
Comments on Fulminant biliary peritonitis.........................
Venkatramani Sitaram
Professor of Surgery, Christian Medical College, Vellore, India
Correspondence Address:
Venkatramani Sitaram
Professor of Surgery, Christian Medical College, Vellore
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Sitaram V. Comments on Fulminant biliary peritonitis......................... Indian J Urol 2006;22:79 |
The author(s) should be congratulated for presenting this fatal complication in their patient as it would help prevent such events in other patients. I understand that an 18 gauge needle is used to puncture the kidney. This would leave a sizable hole in the gall bladder which is unlikely to close. The size of the opening would be more if there has been movement with respiration during the puncture.
The author(s) have recommended immediate cholecystectomy. Facilities/expertise for laparoscopic/open cholecystectomy may not always be available. In this event, a safe option would be to visualize the opening in the gall bladder either through a subcostal incision or by laparoscopy and to convert the opening into a cholecystostomy using a 16Fr Foley catheter. Gallstones if any should be removed before placing the catheter in the gall bladder. The Foley balloon should be inflated with 2-3cc of saline. The opening in the gall bladder is closed around the Foley catheter with a purse-string suture with non-absorbable material and the tube is brought out through a separate stab incision in the abdominal wall. A good tract is formed in 2 weeks. As a measure of abundant precaution a cholangiogram should be performed under antibiotic cover before removing the cholecystostomy. Whether such a patient with a normal gall bladder would need elective cholecystectomy at a later date is debatable
|
