COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy

BMC Surgery

Ruggero Vercelli¹  Carmelo Luigiano²  Roberto Santambrogio³  Marco Giovenzana⁴  Enrico Opocher⁴  Nicolò Maria Mariani⁴  Enrico De Nicola⁴  Carlo Ferrari⁴  Veronica Fedele⁴  Matteo Barabino⁴  Andrea Pisani Ceretti⁴  Gaetano Piccolo⁴  Giovanna Scifo⁴  Vincenzo Nicastro⁴  Massimiliano Mazza⁴  Arianna Trizzino⁴ 

[1] Department of Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan;Unit of Digestive Endoscopy, San Paolo Hospital, University of Milan;Unit of General Surgery, ASST Fatebenefratelli Sacco;Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Science, San Paolo Hospital, University of Milan;

关键词: Acute cholecystitis;    Percutaneous cholecystostomy;    COVID-19;    SARS-CoV-2;    Bedside;    Drainage;   

DOI  :  10.1186/s12893-021-01137-y

来源: DOAJ

【 摘 要 】

Abstract Background COVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis. Methods We analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution. Results Thirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy. Conclusions Percutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

【 授权许可】

Unknown