44 yrs old patient was admited for conservative treatment of acute calculous cholecystitits with complex sever inflamatory pericholecystic reaction with delayed presentation HX more than 3days with high un remmiting fever , after 3days of conservative therapy with IV antibiotics not showing satisfactory response, decision to do do image guide percutanous drainage , which was done successfuly . He had dramatic imprvement afterward,now 2wks post drainage he is doing well drain output around 250 ml /24 hrs, all imaging & labs showed dramatic improvment.tube ligated for 2days to be reevaluated clinically, labs & radiologically.to remove his drain & schedule him for interval cholecystectomy.
In our unite, we do tubogram two weeks after insertion of the rube.If this show free flow of bile in CBD, tube could be taken after six weeks.
Cholecystostomy tube removal has no defined guidelines in literature.
If planning for early cholecystectomy , removal at same sitting.
If staged surgery , atleast 2 weeks / depends on pts clinical condition.
thanks for all comments ,I think its better to wait at least 2wks ,tubogram or no tubogram not making difference, we kept our pt tube for 2wks+ with tubal ligation for last 3days, repeat US then tube removal was uneventful apart from occasional attacks of billiarycolics, BUT the current US image that is almost 8wks post tubal removal still showing thick walled & contracted G B anticepating dificult cholecystectomy.
when you guys think it would be best timing for interval surgery??
patient was successfuly managed by lap cholecystectomy deferred for 10wks post cholecystostomy tube removal, finding was shrinked collapsed thick walled GB otherwise easy dissection.
uneventful post op course.