Management of Clogged Percutaneous Cholecystostomy Tube

Initial Assessment and Management

Evaluate for signs of worsening cholecystitis or sepsis including fever, abdominal pain, distention, jaundice, nausea, and vomiting in patients with clogged percutaneous cholecystostomy tubes, as recommended by the World Journal of Emergency Surgery 1
Assess liver function tests (direct/indirect bilirubin, AST, ALT, ALP, GGT) and inflammatory markers (CRP, PCT) in critically ill patients to evaluate severity, according to the World Journal of Emergency Surgery 1

Consider abdominal triphasic CT as first-line imaging to detect collections and ductal dilation if the tube remains occluded despite thrombolytic therapy, as suggested by the World Journal of Emergency Surgery 1
Use contrast-enhanced MRCP for exact visualization of biliary anatomy if biliary injury is suspected, as recommended by the World Journal of Emergency Surgery 1

For minor bile duct injuries (Strasberg A-D), consider ERCP with biliary sphincterotomy and stent placement, as recommended by the World Journal of Emergency Surgery 1, 2
For major bile duct injuries, consider referral to a center with expertise in hepatopancreatobiliary procedures, according to the World Journal of Emergency Surgery 2
Monitor for signs of biliary peritonitis, which would require urgent abdominal cavity lavage and drainage, as recommended by the World Journal of Emergency Surgery 2