<p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> <p>Distension of the gallbladder and bacterial infection can perpetuate an attack of acute calculous
cholecystitis and produce its local and systemic complications. This prospective randomized trial was
conducted on patients with their first episode of acute calculous cholecystitis which was associated with
pyrexia and tachycardia to examine whether ultrasound guided percutaneous aspiration and lavage of
the gallbladder followed by intra-lumenal instillation of 500 mg ampicillin (PALA) enhanced recovery
from cholecystitis. Twenty patients were randomized to receive 500 mg of ampicillin every 6 hours for 5
days and another 20 patients were randomized to receive this treatment in addition to PALA within 12
hours of admission. Twenty four hours after admission to hospital, all the patients treated with PALA
were apyrexial and had no residual right hypochondrial tenderness or guarding, a result superior (p &lt;
0.001) to that of the group without PALA where at least 75% of patients were still showing these signs.
Two days after admission the WBC count of the PALA group was significantly (p &lt; 0.05) lower than
that of the other group (6.32 ± 0.1 × 10<sup>9</sup>/L vs 10.31 ± 0.4 × 10<sup>9</sup>/L, mean ± SEM, n = 20). Four days
after admission, all members of the PALA group were comfortably tolerating solid food for the previous
24 hours and were, therefore, discharged home whereas all members of the other group were still in
hospital and 85% of them were discharged home after hospitalization for 6 to 7 days. Three members
(15%) of this group deteriorated and underwent emergency surgery.</p> <p>The results show that addition of PALA to the conventional non-operative treatment of acute
cholecystitis enhances recovery and avoids the complications necessitating emergency surgery.</p>
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HPB Surg. 1991; 3(3):167-176