Pediatric Cholecystostomy and Biliary Drain Placement

When surgery is not an option due to the severity of illness of the patient or due to patient and family preference, an interventional radiologist at Children's National Hospital can place a plastic tube into the gallbladder through the skin, which allows drainage of an obstruction of infected fluid, this procedure is call cholecystostomy. Your family will receive significant education on the skin care surrounding the tube as well proper maintenance of the tube and extension material.

When the flow of bile out of the gall bladder becomes blocked due to any reason, inflammation of the gall bladder (cholecystitis) can occur.  This is most commonly the result of stones or debris within the gallbladder or ducts or from external compression of these structures due to tumor.

First choice treatment for cholecystitis is surgery but some patients may not be healthy enough to undergo removal of the gall bladder. In those cases, under general anesthesia, a small tube can be inserted into the gallbladder percutaneously under ultrasound and fluoroscopic guidance. This allows bile to flow external to the patient and into a drainage bag.

In general, a cholecystostomy tube will need to stay in for a duration of four to six weeks to prevent bile leakage into abdomen. In most cases, bile will continue to drain externally until the patient is healthy enough to undergo cholecystectomy. In rare cases, the tube can be capped and eventually removed without cholecystectomy. While in place, the tube will require weekly dressing changes. 

Biliary outflow can become blocked at other locations along the biliary drainage pathway. Commonly, this is the result of stones, debris, strictures and bile duct compression/obstruction from tumors.  Percutaneous drainage of the biliary system may be required.

In this case, a small catheter will be placed into a duct within the liver using ultrasound and fluoroscopy while the patient is under general anesthesia. If the level of obstruction can be crossed, a tube extending from the outside of the patient, traversing through the entire biliary system, and ending within the small bowel will be placed. This allows for the external portion of the catheter to be capped and for bile to flow into the small bowel as it normally does.

If the occlusion, cannot be crossed, only external drainage will be possible, and bile will drain to a drainage bag outside of the patient. External drainage will continue until the occlusion can be crossed or the patient undergoes surgery to alleviate the obstruction. While either tube is in place, weekly dressing changes will be required.

No. We will use either intravenous sedation or general anesthesia so that your child isn’t awake.

Your child will not feel pain during the procedure but some patients may feel discomfort around the tube insertion site for a few days following the procedure. This can be treated by over-the-counter pain medications.

A typical cholecystostomy tube insertion takes about an hour but may take longer. Some children may need to arrive many hours before the procedure to have certain lab tests performed, which will be clearly communicated to you.

The procedure is considered low-risk. However, potential complications include:

• Bleeding
• Tenderness of soreness at the site where the tube is placed
• Infection
• Injury to the gallbladder
• Bile leak (biloma)
• Puncture of the lung (very rare)
• Allergic reaction to X-ray dye (contrast reaction)
• Right shoulder pain (radiating from the liver)
• Clogging of the tube
• Loss of access into the stoma (skin opening over the gallbladder