Acute cholecystitis in elderly patient is almost always a septic condition that can be life threatening. Patients are generally in poor physical status graded in IV ASA score. What is your experience and what do you do?
It is better to do an early laparoscopic surgury after a short corse of medical resuscitation. But in your special poorly medical condition a percutaneous gall bladder drainage with local anesthesia is prefered.
Percutaneous cholecystostomy can be an option, but if the patient has not any surgical contraindication, the best option is early (in the first 24 h) cholecystectomy. We recently published our experience concerning this clinical problem in the American Journal of Surgery 2012; 204: 54.
Minimal invasive approach should be applied like laparoscopy,interventional radiological drainage of GB or bilomas or collections,or even open surgery may be needed in cases of frank biliary peritonitis and gb perforations etc.Overall the entity carries a high risk especially in elderly,diabetics,patients in ICU etc.with other associated co-morbitidies.
Based on age an comorbidities consider a percutaneous colecystostomy with transhepatic approach
Age itself is not a contraindication to the surgical approach. Octa and nonagenarians can be safely operated in the emergency setting if their clinical condition allows to. When facing a ASA III-IV-E patient, old-aged or not, PC should be considered, and when sepsis is resolved, a new clinical assessment be provided to evaluate elective cholecystectomy indication.
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