What is a Cholecystostomy Drainage Tube?
A cholecystostomy drainage tube (also called a percutaneous cholecystostomy or PC tube) is a catheter placed directly into the gallbladder through the skin to drain infected bile or pus in patients with acute cholecystitis who are too sick or high-risk for immediate surgery. 1
Purpose and Function
The tube serves as a temporizing measure that converts a septic patient with acute cholecystitis into a non-septic patient by decompressing the infected gallbladder 2. This drainage removes the source of infection without requiring gallbladder removal, allowing critically ill patients to stabilize.
Technical Placement Details
The transhepatic approach is preferred over transperitoneal because it:
- Reduces risk of bile leak
- Allows the drain to remain in place longer
- Leads to quicker maturation of the drainage tract 1
The procedure is performed under:
- Local anesthesia
- Ultrasound or CT guidance
- Either Seldinger technique (fine needle, multiple steps) or trocar technique (direct 8 French pig-tail insertion) 1
Technical success rates reach 90%, with failures due to small gallbladder lumen, thin wall, or porcelain gallbladder 1.
Tube Management Timeline
The catheter should be removed between 4-6 weeks after placement, but only after confirming biliary tree patency with cholangiography performed 2-3 weeks post-insertion 1. This timeframe allows for tract maturation, making removal safer regarding bile leak risk.
Important caveats for delayed removal:
- Diabetes
- Ascites
- Long-term steroid therapy
- Malnutrition
These conditions hinder tract maturation and require longer drainage periods 1.
Patients can be discharged home with the drain in place 1, which is a key practical advantage over hospitalization.
Complications
Procedure-related complications occur in approximately 3.4% and include 1:
- Bile leak and biliary peritonitis
- Portal or parenchymal vessel injury and bleeding
- Catheter dislodgement
- Colon injury
- Vagal reaction
- Pneumothorax (with transhepatic approach)
The transhepatic route is contraindicated in severe liver disease and coagulopathy 1.
Clinical Context
This intervention is specifically indicated for patients with acute cholecystitis who are not suitable surgical candidates due to severe comorbidities or critical illness 2. The 30-day mortality after PC tube placement can be high (15.4%) 2, reflecting the severity of illness in this patient population rather than the procedure itself.
Following stabilization, delayed cholecystectomy should be offered when perioperative risks decrease, as the 1-year readmission rate without subsequent surgery reaches 49% 2.