Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis: A case report and literature review

BACKGROUND

The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases. Elderly patients are a high-risk group for surgical treatment. If the incarceration of gallstones cannot be relieved, emergency surgery is unavoidable.

CASE SUMMARY

We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. He had several coexisting, high-risk underlying diseases, had a history of radical gastrectomy for gastric cancer, and was taking aspirin before the operation. Nevertheless, he underwent emergency laparoscopic cholecystectomy, with maintenance of postoperative heart and lung function, successfully recovered, and was discharged on day 8 after the operation.

CONCLUSION

Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic, the key is to abide strictly by the hospital’s epidemic prevention regulations, fully implement the epidemic prevention procedure for emergency surgery, fully prepare before the operation, accurately perform the operation, and carefully manage the patient postoperatively.

Predicting factors for the diagnosis of gangrene acute cholecystitis

Background

Gangrenous cholecystitis (GC) must be promptly treated for its high morbimortality. The object of our study is to identify clinical, laboratory or ultrasound factors that might us diagnose GC.

Method

A Retrospective cohort study is devised including all patients admitted to Hospital de Laredo (Cantabria, Spain) between 2015 and 2017 with the diagnose of acute cholecystitis and having been operated. Patients were classified in two groups according to pathology: GC and non-GC. We compared their demographics characteristics, comorbidities, laboratory parameters and ultrasound findings.

Results

A total of 115 patients were operated, of whom 32 had CG and 83 CNG. Neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) showed significantly increased levels in GC group (p = 0.042) and CRP (p < 0.0001). To CRP showed an area under the ROC curve of 0.872 (95% confidence interval: 0.797-0.946). Acalculous cholecystitis was significantly associated to GC (24.1 vs. 7%; p < 0.005). In the multivariate analysis only the CPR showed as a predictive factor. A cutting point of CRP at 15.25 mg/dl, that had high sensibility (90.6%) and high negative predictive value (95%).

Conclusion

CRP helped identify patients with CG to indicate early surgical intervention.

A case of peritoneal free floating calcified fibromyoma

Giant peritoneal loose bodies are rare and few reported cases are found in literature. These are commonly found in the pelvis. Preoperatively these cases are diagnosed accidentally on abdominopelvic evaluation. We report one such case in a male patient who presented to us with acute gangrenous cholecystitis. We had diagnosed the lesion accidentally on a routine ultrasound of the abdomen and pelvis as a calcified leiomyoma of sigmoid colon. On laparoscopy, it was freely floating in the peritoneal cavity without any kind of peritoneal attachment or attachment to any intraperitoneal organ. The peritoneal loose body was removed by a small abdominal incision. Histopathologically the lesion was reported as benign calcified fibromyoma. Small peritoneal loose bodies are relatively common but a large peritoneal loose body is very rare.