A surgeon and colleague of mine who had run into some roadblocks with interventional radiology on a particular week (renovations to the interventional room) asked me to help him out with an acute cholecystitis whom he wanted to optimize first and later operate semi-electively (elderly, some acute renal failure with the acute cholecystitis) and needed a drainage procedure.

In this case, the gall bladder was quite superficial and was easily punctured.  Note the confirmation of wire position in the gall bladder lumen at about 4:00 min, which is an important step to ensure proper position prior to dilation and pigtail insertion. Also note the final confirmation of position by aspiration of pus. She ended up draining about 250cc of purulent and foul-smelling material.

This video illustrates the procedure and shows how feasible and relatively easily this can be done. Such an approach can be immensely useful in situations where a surgeon or an operating room are not available, if the anatomy allows. In this case the patient improved rapidly and was operated successfully in the following weeks.

The technique of ultrasound spotted or guided pigtail catheter insertion is remarkably simple and safe in experienced hands, saving significant time and patient transport risks (especially ICU patients).  It is a seldinger technique which should be familiar to any acute care physician used to inserting central lines. In my opinion this should be part of the armamentarium of any acute care doc.

Please don’t hesitate if anyone has questions!

Philippe