Cholecystostomy for Acalculous Cholecystitis with Haemobilia in a Lung Transplant Patient; A Case Report.

CMV Polymerase Chain Reaction analysis was positive for both serum and bile and a diagnosis of CMV acalculous cholecystitis with haemobilia was established. The patient was treated with intravenous ganciclovir for 25 days followed by 18 days of oral valganciclovir. T-Tube cholangiogram 2 weeks following initial insertion demonstrated no flow out of the common bile duct into the duodenum. A Magnetic Resonance Cholangiopancreatography (MRCP) scan (with a view of proceeding to ERCP) demonstrated a normal biliary tree, but showed debris in the gallbladder suggestive of posthaemorrhagic components. A repeat T-tube cholangiogram one week later showed an obstruction at the gallbladder neck. This was managed with two instillations of 25000I/U of streptokinase into the cholecystostomy drain 12 hours apart. Repeat T-tube cholangiogram following this demonstrated normal flow of contrast through the common bile duct into the duodenum. The pig tail drain was subsequently removed (day 42) and the patient made a good post-procedure recovery.