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Delayed laparoscopic cholecystectomy for a patient with coronavirus disease 2019 who developed gangrenous
Yurie Yoshida1, Tomohiro Iguchi2, Norifumi Iseda1
1Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.
Insights
Gangrenous cholecystitis management was altered during the COVID-19 pandemic. A patient with asymptomatic COVID-19 successfully managed with antibiotics, delaying surgery until negative test results, avoiding complications.
Area of Science:
- Hepatobiliary surgery
- Infectious disease management
- Pandemic response
Background:
- Gangrenous cholecystitis necessitates early cholecystectomy due to high perforation and sepsis risks.
- The COVID-19 pandemic significantly impacted emergent surgical management protocols to mitigate contagion and adverse outcomes.
Purpose of the Study:
- To present a case of acute gangrenous cholecystitis in an asymptomatic COVID-19 patient.
- To inform treatment strategies for similar cases during pandemics.
Main Methods:
- A 56-year-old male presented with symptoms of acute gangrenous cholecystitis.
- Initial management included antibiotics and planned percutaneous transhepatic gallbladder drainage (PTGBD) due to asymptomatic COVID-19 positivity.
- Delayed laparoscopic cholecystectomy was performed after negative COVID-19 test results.
Main Results:
- Antibiotic therapy alone proved effective, obviating the need for immediate PTGBD.
- The patient's condition improved, allowing for a delayed laparoscopic cholecystectomy.
- The delayed surgery resulted in an uneventful recovery.
Conclusions:
- Acute gangrenous cholecystitis can occur in asymptomatic COVID-19 patients.
- Conservative management with antibiotics and delayed surgery is a viable strategy during pandemics.
- This case highlights the need for adaptive treatment protocols in emergent surgical conditions during global health crises.
Background:
Gangrenous cholecystitis has a high risk of perforation and sepsis; therefore, cholecystectomy in the early stage of the disease is recommended. However, during the novel coronavirus disease 2019 (COVID-19) pandemic, the management of emergent surgeries changed to avoid contagion exposure among medical workers and poor postoperative outcomes.
Case Presentation:
A 56-year-old man presented to our hospital with abdominal pain. Computed tomography revealed intraluminal membranes, an irregular or absent wall, and an abscess of the gallbladder, indicating acute gangrenous cholecystitis. Early laparoscopic cholecystectomy seemed to be indicated; however, a COVID-19 antigen test was positive despite no obvious pneumonia on chest computed tomography and no symptoms. After discussion among the multidisciplinary team, antibiotic therapy was started and percutaneous transhepatic gallbladder drainage (PTGBD) was planned for the following day because the patient's vital signs were stable and his abdominal pain was localized. Fortunately, the antibiotic therapy was very effective, and PTGBD was not needed. The cholecystitis improved and the patient was discharged from the hospital on day 10. One month later, laparoscopic delayed cholecystectomy was performed after confirming a negative COVID-19 polymerase chain reaction test result. The postoperative course was uneventful, and the patient was discharged on postoperative day 2 in satisfactory condition.
Conclusion:
We have reported a case of acute gangrenous cholecystitis in a patient with asymptomatic COVID-19 disease. This report can help to determine treatment strategies for patients with gangrenous cholecystitis during future pandemics.
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