Delayed laparoscopic cholecystectomy for a patient with coronavirus disease 2019 who developed gangrenous cholecystitis: a case report

Abstract

Background: Gangrenous cholecystitis has a high risk of perforation and sepsis; therefore, cholecystectomy in the early stage of the disease is recommended. However, during the novel coronavirus disease 2019 (COVID-19) pandemic, the management of emergent surgeries changed to avoid contagion exposure among medical workers and poor postoperative outcomes.

Case presentation: A 56-year-old man presented to our hospital with abdominal pain. Computed tomography revealed intraluminal membranes, an irregular or absent wall, and an abscess of the gallbladder, indicating acute gangrenous cholecystitis. Early laparoscopic cholecystectomy seemed to be indicated; however, a COVID-19 antigen test was positive despite no obvious pneumonia on chest computed tomography and no symptoms. After discussion among the multidisciplinary team, antibiotic therapy was started and percutaneous transhepatic gallbladder drainage (PTGBD) was planned for the following day because the patient's vital signs were stable and his abdominal pain was localized. Fortunately, the antibiotic therapy was very effective, and PTGBD was not needed. The cholecystitis improved and the patient was discharged from the hospital on day 10. One month later, laparoscopic delayed cholecystectomy was performed after confirming a negative COVID-19 polymerase chain reaction test result. The postoperative course was uneventful, and the patient was discharged on postoperative day 2 in satisfactory condition.

Conclusion: We have reported a case of acute gangrenous cholecystitis in a patient with asymptomatic COVID-19 disease. This report can help to determine treatment strategies for patients with gangrenous cholecystitis during future pandemics.

Keywords: COVID-19; Gangrenous cholecystitis; Laparoscopic cholecystectomy.

Fig. 1

A Contrast-enhanced computed tomography revealed specific findings of gangrenous cholecystitis, including intraluminal membranes, an irregular or absent wall, and abscess formation. B Chest computed tomography showed no evidence of pneumonia

Fig. 2

Magnetic resonance cholangiopancreatography revealed small gallstones in the gallbladder (arrowhead) and common bile duct (arrow)

Fig. 3

Intraoperative examination revealed a thickened gallbladder wall that was partially inflamed

Fig. 4

Macroscopically, diffuse mucosal necrosis was observed in the gallbladder fundus (A). Microscopic findings showed transmural ischemic necrosis of the gallbladder fundus (B)