Acute Acalculous Cholecystitis in a Patient with Covid - 19

Abstract

Acute alithiasic cholecystitis (AAC), also called acalculous, corresponds to the presence of an inflammation of the gallbladder in the absence of stones inside, it is a rare entity (10%), reported in diabetic patients, immunosuppressed, with pathologies infectious (viral, bacterial), major surgery, drugs, multiple trauma, mechanical ventilation, use of vasopressors, opioid analgesics, prolonged fasting, total parenteral nutrition, burns, among others. In this time of the SARS CoV-2 virus / COVID-19 coronavirus disease pandemic, surgeons have found an increase in the request for interconsultations from respiratory hospitalization services, intermediate care and intensive care units, due to ultrasound findings of incidental abdomen of acute alithiasic cholecystitis in those patients without improvement to treatment or worsening of sepsis, or the cytokine cascade, difficult to evaluate abdominal epigastric pain, right upper quadrant, induces us to explore and find little painful palpable gallbladder, reporting edema gallbladder wall greater than 3 mm, gallbladder distention, sometimes ultrasound Murphy's sign, extending imaging studies according to the patient's conditions with contrasted computed axial tomography and nuclear magnetic cholangioresonance, and even with reports of micro perforations with peri-vesicular extravasation of contents , free air on its walls, ruling out other causes of acalculous cholecystitis. It is a real diagnostic and therapeutic challenge in these patients with the SARS virus -COV-2 / COVID-19, already afflicted by viremia, or in some cases subjected to cytokine storms, poor general conditions, hermodynamically unstable in Intensive care units, intubated, with vasopressor support, and even some overcoming the emergency, what would be the best time to resolve Acute acalculous cholecystitis medically or surgically? This is the big question.

Analysis of management tactics of patients with acute noncalculous cholecystitis in combination with coronavirus disease

“…Запалення жовчного міхура внаслідок блоку відтоку жовчі конкреметом є найпоширенішою формою, що складає близько 85% усіх випадків. Гострий некалькульозний холецистит є досить рідкісною етіологічною формою запалення жовчного міхура, близько 15% від загальною кількості гострих холециститів [7]. Морфологічно розрізняють катаральні, флегмонозні та гангренозні форми.…”

Visión del cirujano en la colecistitis aguda acalculosa y Covid-19 (enfermedad por SARS-CoV-2)

“…En la visión del cirujano general, la CAA comúnmente se relaciona con pacientes diabéticos, inmunodeprimidos, con lupus, internados en UCI y menos frecuentemente como dengue, bacteremias por Salmonella tiphy y Estafilococo, entre otros, que podrían colonizar la vesícula biliar (2).…”

“…La incertidumbre sobre si a futuro se podrán realizar cultivos rutinarios del jugo biliar con RT-PCR se mantiene, aunque ya se han mostrado ejemplos de su imposibilidad. (2).…”