Acute acalculous cholecystitis on a COVID-19 patient: a case report

Abstract

Background coronavirus disease-19 (COVID-19) has spread to several countries around the world and has become an unprecedented pandemic. We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient. Case presentation: a COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient’s clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform. Conclusions acalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhea. Although the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients.

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

“…The characteristics of included trials were presented in Table 1 . A total of 269 patients from 47 studies [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 [95% CI, 42.49; 59.34], and 49% [95% CI, 0.33, 0.65] patients were female.…”

Acute Acalculous Cholecystitis Caused by Candida Albicans in a COVID-19 Patient: A Case Report

“…Acalculous cholecystitis has been reported previously after an acute infection with Epstein Barr virus (EBV) [8]. Also, a case of acute acalculous cholecystitis has been reported in a COVID-19 patient but with no pathogen identi cation [9]. Our case represents an acute acalculous cholecystitis possibly associated with COVID-19, and the causative organism was identi ed as Candida albicans.…”

Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues

“…We encountered 7 case reports published about Covid-19 suspects or infected patients who underwent laparoscopic procedures (appendicectomy, cholecystectomy, perforated ulcer repair, internal hernia repair) [43][44][45][46][47][48][49]. The RT-PCR did not evidence the presence of viral ARN in peritoneal lavage, but, when tested it was present in stools +/− digestive wall in 50% of them.…”

“…Mattone et al [49] reported a case of gangrenous acalculous cholecystitis in a patient hospitalized for COVID-19 pneumonia for 43 days in ICU. He followed the protocol, tempting a less invasive approach, percutaneous drainage, than followed by laparoscopic cholecystectomy.…”