Percutaneous Aspiration, Lavage and Antibiotic Instillation

Further to my recent publication in the Journal on the percutaneous management of acute calculous cholecystitis1, I would like to communicate the results of a prospective randomized study conducted at the Medical City in Baghdad, Iraq to examine the role of percutaneous aspiration of the gallbladder followed by lavage and antibiotic instillation into its lumen (500 mg ampicillin with 40 mg gentamicine, PALA) when conservative management of acute cholecystitis appears to be failing. Patients judged suitable for the study were those presenting with clinical signs and symptoms (including a positive Murphy's sign) of acute cholecystitis coupled with pyrexia (more than 38 C), tachycardia, leucocytosis, normal serum amylase levels and liver function tests, and ultrasonic evidence of a distended gallbladder containing one or more stones. These patients were treated conservatively. They were completely fasted, confined to bed, given 50 mg pethidine intramuscularly, hydrated intravenously, allowed nil orally for at least 24 hours, and intravenously treated with 1.2 grams of Augmentin (amoxycillin 1 g and clavulanic acid 200 mg, Beecham Research Labs, Brentford, U.K.) every 8 hours. When this treatment proved unsuccessful (failure of fever or tachycardia to show unequivocal evidence of remission or of tenderness and rigidity to subside within 36 hours of beginning nonoperative treatment), patients were fasted, their antibiotic stopped, and after giving written informed consent, they were randomized by drawing sealed envel