Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature

Abstract

BACKGROUND Research concerning postoperative outcomes of confirmed coronavirus disease 2019 (COVID-19) patients revealed unfavorable postoperative results with increased morbidity, pulmonary complications and mortality. Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis. The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with concomitant acute cholecystitis who underwent cholecystectomy. CASE SUMMARY We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy. Six patients were males, the mean age was 47.1 years. Nine patients had moderate acute cholecystitis, and one patient had severe acute cholecystitis. All patients were treated with urgent/early laparoscopic cholecystectomy. Regarding the Parkland grading scale, two patients received a Parkland grade of 3, two patients received a Parkland grade of 4, and six patients received a Parkland grade of 5. Eight patients required a bail-out procedure. Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy. After surgery, five patients developed acute respiratory distress syndrome (ARDS) and required intensive care unit (ICU) admission. One patient died after cholecystectomy due to ARDS complications. The mean total length of stay (LOS) was 18.2 d. The histopathology demonstrated transmural necrosis ( n = 5), vessel obliteration with ischemia ( n = 3), perforation ( n = 3), and acute peritonitis ( n = 10). CONCLUSION COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.

Laparoscopic cholecystectomy for acalculous, gangrenous cholecystitis on an outpatient COVID-19 adult: a case report

“…Previous studies confirmed the biliary tropism of the novel coronavirus [ 1 ]. Literature reports suggested a more aggressive presentation of cholecystitis, regardless of the presence or not of cholelithiasis [ 1 ].…”

“…Previous studies confirmed the biliary tropism of the novel coronavirus [ 1 ]. Literature reports suggested a more aggressive presentation of cholecystitis, regardless of the presence or not of cholelithiasis [ 1 ]. These associated biliary manifestations are considered to be the result of a dysregulated inflammatory response, rather than a direct viral injury [ 2 , 3 ].…”

“…Acalculous gangrenous cholecystitis has been, also, reported in COVID-19 patients. Although most cases consist of septic or under mechanical ventilation patients, there are reports of mild-to-moderate COVID-19 patients that developed acute cholecystitis; in fact, current literature suggests a more aggressive disease in infected patients [ 1 ].…”

Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review

“…Furthermore, SARS-CoV-2 can directly affect the gallbladder’s epithelial cells because of the high expression of ACE2 receptors among them [ 99 ]. In a study by Bozada-Gutiérrez et al, a histopathological examination showed ischemia and necrosis (because of thrombosis in the small vessel), hemorrhagic changes, and acute inflammatory infiltrates in the gallbladder wall, accompanied by acute peritonitis [ 100 ].…”

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

“…During the COVID-19 pandemic, we observed an increased number of AC patients who presented with gangrenous acute cholecystitis. An early case series showed that COVID-19 infection and pneumonia were associated with GC with increased morbidity and mortality, mainly in elderly and frail patients [5][6][7][8][9].…”