From the Guidelines
Elevated white blood cell (WBC) count after percutaneous cholecystostomy tube placement is commonly due to an inflammatory response to the procedure itself or ongoing infection, with the most common causes including persistent cholecystitis, tube-related infection, bile leak, or systemic inflammatory response syndrome (SIRS) 1.
Causes of Elevated WBC
The causes of elevated WBC count after percutaneous cholecystostomy tube placement can be multifactorial, including:
- Persistent cholecystitis
- Tube-related infection
- Bile leak
- Systemic inflammatory response syndrome (SIRS) These causes are supported by studies that have shown that percutaneous cholecystostomy can be effective in reducing leukocytosis, C-reactive protein, and fever in patients with acute cholecystitis 1.
Management
If a patient shows elevated WBC counts post-procedure, clinicians should first evaluate for signs of infection at the insertion site such as redness, swelling, or purulent drainage. Systemic symptoms like fever should also be assessed.
Treatment Options
Management typically involves:
- Broad-spectrum antibiotics such as piperacillin-tazobactam 3.375g IV every 6 hours or ceftriaxone 1-2g daily plus metronidazole 500mg every 8 hours while awaiting culture results
- Assessment of the tube for proper positioning and function, with consideration for tube exchange if blockage is suspected
- Blood cultures and imaging studies may be necessary to identify complications like abscess formation The inflammatory response typically resolves within 48-72 hours after successful treatment, but persistent elevation may indicate a need for tube removal or more aggressive intervention 1.
Considerations
It is essential to note that percutaneous cholecystostomy is a reasonable option for the emergency setting management of elderly high-risk patients having acute calculous cholecystitis (ACC) 1. However, the current role of percutaneous cholecystostomy in ACC is not clear, and further studies are needed to determine its effectiveness 1.
From the Research
Causes of Elevated WBC after Percutaneous Cholecystostomy Tube
- Infection or inflammation at the site of the percutaneous cholecystostomy tube placement may cause an elevated white blood cell (WBC) count 2, 3
- Biliary tract infections, such as cholecystitis or cholangitis, can also lead to an elevated WBC count 4
- The presence of a percutaneous cholecystostomy tube can increase the risk of infection, which may cause an elevated WBC count 2, 3
- The use of antibiotic agents, such as ciprofloxacin, may be effective in treating biliary tract infections and reducing the WBC count 4
- However, the routine use of peri-operative antibiotic agents in low-risk patients undergoing elective laparoscopic cholecystectomy is not recommended 5
Factors Associated with Elevated WBC after Percutaneous Cholecystostomy Tube
- The degree of illness at the time of percutaneous cholecystostomy tube placement may not influence the rate of success of laparoscopic interval cholecystectomy, but may affect the WBC count 6
- Patients with a lower Charlson Comorbidity Index and fewer previous abdominal operations may be more likely to undergo successful laparoscopic interval cholecystectomy and have a lower WBC count 6
- The incidence of common bile duct (CBD) injuries is higher during subsequent cholecystectomy after percutaneous cholecystostomy tube placement, which may cause an elevated WBC count 3