From the Guidelines
Pericholecystic fluid is a significant finding that indicates inflammation of the gallbladder, known as cholecystitis, and requires prompt medical attention, which may include antibiotics, pain management, and surgical consultation for possible cholecystectomy 1. When pericholecystic fluid is identified, patients typically present with right upper quadrant pain, fever, nausea, and vomiting, and other associated findings may include gallbladder wall thickening (>3mm), gallstones, and a positive sonographic Murphy's sign. The presence of pericholecystic fluid increases the likelihood of complicated cholecystitis and may indicate a more urgent need for surgical intervention rather than conservative management. Some key points to consider in the management of pericholecystic fluid include:
- Ultrasound is the first choice of investigation for biliary symptoms or right upper quadrant abdominal pain, and it is very accurate at diagnosing or excluding gallstones 1.
- The diagnosis of acute cholecystitis is made on the basis of clinical features such as right upper quadrant pain, fever, and leukocytosis, and is supported by findings from relevant imaging studies, including ultrasound and CT scans 1.
- Early laparoscopic cholecystectomy (ELC) is a safe and effective treatment for acute cholecystitis, and it is generally recommended for patients who are fit to undergo surgery 1.
- In patients with moderate or severely symptomatic cholecystitis, or in those with mildly symptomatic acute cholecystitis who prefer surgery, laparoscopic cholecystectomy is preferred over open cholecystectomy 1.
- Percutaneous cholecystostomy tube placement may be necessary for gallbladder drainage and relief of inflammation in some cases, especially if surgery is contraindicated 1.
From the Research
Pericholecystic Fluid
- Pericholecystic fluid is a radiologic feature that can be predictive of a positive response to percutaneous cholecystostomy in patients with gallstones 2
- The presence of pericholecystic fluid, along with other radiologic findings such as gallstones, gallbladder wall thickening, and distention, can indicate a higher likelihood of response to percutaneous cholecystostomy 2
- However, the presence of pericholecystic fluid is not a definitive indicator of acute cholecystitis, and other diagnostic criteria and severity scores should be considered in the diagnosis and management of the condition 3, 4, 5, 6
Diagnostic and Management Considerations
- Percutaneous cholecystostomy is typically employed in the management of critically ill patients who are not surgical candidates 4
- The role of percutaneous cholecystostomy as a bridge to surgery or as an alternative to surgery in unfit patients with acute calculous cholecystitis is still being debated 5, 6
- Laparoscopic cholecystectomy is generally considered the best treatment for acute calculous cholecystitis, and early surgery is associated with better results than delayed surgery 3, 6
Radiologic Features and Response to Treatment
- The presence of pericholecystic fluid, along with other radiologic findings, can be predictive of a positive response to percutaneous cholecystostomy 2
- The number and type of radiologic investigations, including the presence of gallstones, gallbladder wall thickening, distention, and pericholecystic fluid, should be considered in the diagnosis and management of acute cholecystitis 2