Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2022; 10(4): 1296-1310
Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1296
Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature
Katya Bozada-Gutiérrez, Mario Trejo-Avila, Fátima Chávez-Hernández, Sara Parraguirre-Martínez, Carlos Valenzuela-Salazar, Jesús Herrera-Esquivel, Mucio Moreno-Portillo
Katya Bozada-Gutiérrez, Mario Trejo-Avila, Fátima Chávez-Hernández, Carlos Valenzuela-Salazar, Jesús Herrera-Esquivel, Mucio Moreno-Portillo, Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
Sara Parraguirre-Martínez, Department of Pathology, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
Author contributions: Bozada-Gutiérrez K designed and performed the research, contributed to the analysis and wrote the paper; Trejo-Avila M designed the research, contributed to the analysis, wrote the paper, provided clinical advice and supervised the report; Chávez-Hernández F designed and performed the research, contributed to the analysis; Parraguirre-Martínez S performed the research, provided histopathological images and interpretation, contributed to the analysis; Valenzuela-Salazar C, Herrera-Esquivel J and Moreno-Portillo M designed the research, contributed to the analysis, provided clinical advice and supervised the report.
Informed consent statement: Informed consent was waived by competent authorities due to the use of anonymous data and due to its retrospective nature.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) Statement and the manuscript was prepared and revised according to the CARE Checklist (2016) Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mario Trejo-Avila, MD, Surgeon, Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Calzada de Tlalpan 4800, Mexico City 14090, Mexico. mario.trejo.avila@gmail.com
Received: July 27, 2021
Peer-review started: July 27, 2021
First decision: October 3, 2021
Revised: October 16, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: February 6, 2022
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.

Keywords: COVID-19, SARS-CoV-2, Cholecystectomy in COVID-19, Acute cholecysti- tis in COVID-19, Case report

Core Tip: Several studies have described multiple gastrointestinal complications in patients with coronavirus disease 2019, including advanced stages of cholecystitis. we found in the present study that patients with confirmed severe acute respiratory syndrome coronavirus 2 infections who presented with acute cholecystitis, tended to have a higher grade on the Parkland grading scale (including gallbladder perforation, empyema and total wall necrosis), had difficult laparoscopic cholecystectomies with an increased need for a bail-out procedure, had high rates of intensive care unit admission, and had a prolonged length of hospital stay.