Friday, December 24, 2004

Fun with Interventional Radiology....
Asked to see a 70-ish man admitted with altered mental status. History of severe COPD and diabetes. Develops an acute MI. Found to have abdominal pain and gallbladder sludge. WBC's 20,000 and patient becomes hypotensive. CT scan obtained:

Some ascities.

Stones within a hydropic gallbladder.

inflammatory changes in the right upper quadrant.
The last thing this patient needs is an operation, fortunately there is another option, a cholecystostomy tube. It will allow the gallbladder to be decompressed and may be left in place indefinitely. The patient can undergo cholecystectomy when medically stable.

The needle inserted percutaneously.

One cut of the 8 french pigtail.

The pigtail within the gallbladder.
Afebrile today with WBC down to 13,000. BP and mental status improved.
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