Radiology, Vol 151, 377-380, Copyright © 1984 by Radiological Society of North America
Life-threatening vagal reactions associated with percutaneous cholecystostomy
E vanSonnenberg, VW Wing, JW Pollard and G Casola
In four of our initial five cases of percutaneous cholecystostomy,
performed under ultrasound guidance for septicemia due to suspected cystic
duct obstruction and hydrops of the gallbladder, patients suffered profound
vagal reactions with severe hypotension and bradycardia. One patient had
cardiac arrest. The patients had experienced recent myocardial infarction,
ventricular ectopy, or septicemia, and each had a greatly distended
gallbladder. The reactions occurred immediately, though in the first
patient recognition was delayed. One patient had infected bile, three had
obstructing cystic duct stones with inflammatory response, and one had a
sterile and nonobstructed gallbladder. All patients survived the acute
insult. Treatment consisted of minimizing intravisceral manipulations,
administration of intravenous atropine, fluids, antibiotics, and dopamine.
Atropine administered prior to the procedure appeared to blunt the reaction
in one patient. Two patients died within a week of other causes. At autopsy
neither peritoneal cavity had bile staining. The other patients had
follow-up ultrasound examinations; no intraperitoneal fluid collections
were seen.
