An underestimated “false negative COVID cholecystitis” in Northern Italy and the contagion of a surgical ward: it can happen everywhere

Abstract

A 45-year-old healthy woman was admitted to our Emergency Department (ER) with severe abdominal pain in the right abdominal quadrant and high fever. Blood test showed elevated levels of white blood cells (17,700 per ml) and high C reactive protein level (24,802 mg/ml [range 0-5]), while procalcitonin level was normal. Abdominal ultrasound revealed an acute cholecystitis with no free fluid in the abdomen. Temperature was 37.9° Celsius (C) at admission. The patient was then admitted to our Surgical Department and antibiotic therapy was started with Ceftriaxone 2 g/24. The patient underwent urgent laparoscopic cholecystectomy 10 h after admission in the ER. A bile spilling from the gall bladder occurred during the laparoscopic procedure. Bile was collected and sent for microbiological examination. A surgical drain was place under the liver.On the second post-operative day, the patient still showed high temperature. Bile microbiological examination revealed the presence of multi-sensible Enterococcus faecium and Serratia marcescens. Antibiotic therapy was, therefore, switched to ampicillin and ciprofloxacin. Blood cultures resulted negative for sepsis. Following the onset of dry cough and slight desaturation (sO2 96%

Cholecystectomy during the COVID-19 pandemic: Current evidence and an understanding of the ‘new’ critical view of safety: Correspondence

“…Cholecystectomy is one of the commonest abdominal surgeries performed worldwide. To date, there are several reports of COVID-19 patients undergoing cholecystectomy, including our institution's experience [3][4][5][6]. Taking into account current available evidence, we provide some recommendations for performing cholecystectomy safely in suspected, presumed or confirmed COVID-19 patients.…”

“…It was previously suggested that a pre-operative chest X-ray and nasopharyngeal swab should be performed for all elective procedures. However, with better understanding that pre-symptomatic viral transmission can occur [12] and nasopharyngeal swab results may be negative in the initial phase of disease [4], these measures alone may not be sufficient. In our institution, we call our patients 72 hours prior to surgery to ensure that they have no acute respiratory illness or recent travel history [2,11].…”