Abstract
A 77-year-old woman who had been given an oral anti-platelet drug for diabetes mellitus, hypertension, cirrhosis, and carotid arterial sclerosis visited a hospital because of a seven-day history of right hypochondralgia. Conservative therapy for acute cholecystitis was unsuccessful and, three days later, she was referred to our hospital. When she was first seen, she had moderate degree of acute cholecystitis, sepsis, and DIC. We considered percutaneous transhepatic gallbladder drainage (PTGBD), but the patient was not a candidate because of collection of ascites. ETGBD was unsuccessful as well and exploratory laparotomy was performed. As ten days had elapsed after the onset of symptom, she had been on internal medication of an anti-platelet drug, and she had cirrhosis, laparoscopic combined PTGBD was performed for probable risk of complications. After confirmed that no intraoperative bleeding occurred, we terminated the operation while an information drain was placed in the right subphrenic structure. She required artificial respiratory management after the operation, but the drain could be withdrawn on the second postoperative day. The postoperative course was uneventful and she was discharged from our hospital while PTGBD had been dwelt. Three months later, laparoscopic cholecystectomy was performed.
Since lparoscopic combined PTGBD is considered to be a drainage method of choice for acute cholecystitis, the case is presented here.
