Contrast-enhanced ultrasound for diagnosis and follow-up of complicated acute cholecystitis treated with percutaneous cholecystostomy: a case report

Acute cholecystitis in patients with multiple comorbidities and advanced malignancy presents unique diagnostic and therapeutic challenges. Contrast-enhanced ultrasound (CEUS) has emerged as a valuable tool for diagnosing complicated cholecystitis and guiding interventional procedures. A 69-year-old male with locally advanced pancreatic head carcinoma, chronic ischemic heart disease, and COPD who developed complicated acute cholecystitis with pericholecystic abscess. CEUS confirmed the diagnosis and guided percutaneous cholecystostomy placement via a transperitoneal approach. Intracavitary CEUS through the drainage catheters was subsequently used to verify correct positioning, assess gallbladder perforation, evaluate cystic duct patency, and monitor treatment response. The patient showed progressive clinical and laboratory improvement, with successful resolution of the acute episode without requiring emergency surgery.