Outcomes of symptomatic gallstone disease in pregnant women: A retrospective study

Gallstone disease with advanced symptoms is one of the common abdominal emergencies during pregnancy and it is considered to be one of the most frequently reported non-obstetric surgical conditions in pregnant women. This study aimed to evaluate the outcomes of surgical cholecystectomy in pregnant women with symptoms of advanced gallstones. This is a retrospective analysis of 2814 pregnant women who attended various wards in government and private hospitals in the governorates of Diyala and Kirkuk in Iraq for more than 2 years, between February 2020 and June 2022. The hospital database was used to confirm the diagnosis of advanced gallstone symptoms in these pregnant women. The incidence of symptomatic gallstones in pregnant women, diagnosis and method of therapeutic management, cholecystectomy according to the pregnancy periods, and perinatal complications of patients according to therapeutic methods were determined. The results confirmed that out of 2814 pregnancies, only 126 (4%) had symptoms of gallstones. It was found that the majority of cases 67 (53%) were within the first trimester of pregnancy and the least 29 (23%) was observed in the second trimester. Acute cholecystitis was the generality 84 (67%) diagnosed in pregnant women with symptomatic gallbladder disease and only 9 (7%) of the patients had undergone prenatal cholecystectomy versus 117 (93%) who were managed conservatively. A total of 20 (16%) cases with undesirable complications were recorded, where 12 cases with low birth weight were noted, where 4 of them underwent surgery and 8 were treated conservatively. It was concluded that a large proportion of women suffer from symptoms of gallstones during pregnancy. Most cases can be managed conservatively, and intervention should be performed as often as needed.Copyright © 2023, Codon Publications. All rights reserved.

Beware of Rattling Underfoot: Cystic Artery Pseudoaneurysm in Acute Cholecystitis With a Cholecystostomy.

Cystic artery pseudoaneurysm (CAP) is a very rare complication of acute cholecystitis. The pathogenesis of CAP in the context of cholecystitis is unknown but is possibly related to the inflammatory process in the vicinity of the cystic artery, leading to weakness in the wall of the artery. Though CAP has been reported in the literature, our patient had a unique presentation in the presence of a cholecystostomy catheter in situ. There were no risk factors for CAP in our patient including usage of anticoagulants, trauma, or surgical procedures. Fortunately, the blood-stained fluid in the cholecystostomy catheter effluent alerted the clinical team to a possible vascular complication in the background of ongoing cholecystitis. This finding should serve as a warning sign to alert clinicians to the possibility of CAP-beware of rattling underfoot.

Abdominal Imaging Findings in Patients with COVID-19 Part 2: Solid Organs

[...]although solid abdominal organs are rarely affected by COVID-19, clinicians must be familiar with the manifestations since they are associated with the disease severity and poor outcome. Keywords: COVID-19, Abdominal, Imaging, Computed tomography, Ultrasonography Introduction The world has been confronting the upsurge of coronavirus disease 2019 (COVID-19) since the first novel coronavirus infection (SARS-CoV-2) initially emerged in China in December 2019.1 The most common symptoms reported in COVID-19 are related to respiratory system involvement, including fever, dry cough, fatigue, and dyspnea.2 Angiotensin-converting enzyme 2 (ACE2) plays a significant role in mediating the inflammation of COVID-19, which can contribute to COVID-19 manifestations.3 ACE2 receptors are found in various cells, including hepatocytes, cholangiocytes, podocytes, and enterocytes.2,3 Forty percent of infected patients have shown gastrointestinal (GI) manifestations, including loss of taste, nausea, vomiting, diarrhea, and abdominal pain.4 A significant number of patients have GI symptoms, and sometimes it is the only presentation of the disease without respiratory manifestations.2 The reverse-transcriptase polymerase-chain-reaction (RT-PCR) diagnostic test and chest computed tomography (CT) were reported to be highly sensitive in the early diagnostic stage of suspected COVID-19.5 Cross-sectional abdominal imaging is not usually used in COVID-19.6 Nevertheless, abdominal CT may be performed if specific symptoms exist, such as abdominal pain. Radzina et al found that multiparametric ultrasonography may be more sensitive than CT and Magnetic resonance imaging in assessing liver damage at the cellular level in patients with COVID-19 before progressing into liver cirrhosis.37 Pancreas Given the fact that ACE2 receptors are vastly expressed in pancreatic islet cells, COVID-19 can induce islet cell damage presenting with acute diabetes.38 The pancreatic involvement can occur through the direct invasion by SARS-CoV2, a systemic response to pneumonia, or a destructive immune reaction due to viral stimulation.19 According to Wang and colleagues, the pancreas was affected in 17% of patients with COVID-19 pneumonia.19 In reported cases of SARS-CoV-2 infection, abdominal CT revealed features of acute pancreatitis, including edema and inflammation of the pancreas with surrounding fluid collections and fat stranding30-39 (Figure 3). Kidney According to Pei et al, the most prevalent renal abnormalities in the setting of COVID-19 were proteinuria and hematuria, with acute kidney injury (AKI) happening less often.50 Renal infarct might occur because of hypercoagulation.6 The possible mechanisms of AKI in COVID-19 might be related to a variety of factors, including cytokine release syndrome, hypoxia, endotoxin produced by superimposed infections during ICU admission, and rhabdomyolysis.51 Different studies have established that AKI considerably increased the mortality rate in admitted patients with COVID-19.20 Renal parenchymal hypodensity and perirenal fat stranding on non-enhancement CT in patients with COVID-19 represent severe renal impairment.52 Like the spleen, the most common renal finding in abdominal tomograms was infarction.12 In such conditions, the affected kidney presents with patchy, sharply demarcated heterogeneous areas with hypoenhancement.6 A summary of renal imaging findings is shown in Table 6.

Symptomatic gallstone disease in adolescence: an increase in incidence during COVID-19 pandemic

BackgroundThe incidence of gallstone disease in children and adolescents remains to be a rare disease within this population but appears to be increasing during the COVID-19 pandemic.The aim of this study was to evaluate the increase in the trend of symptomatic gallstone disease in adolescence in relation to hospitalization during the COVID-19 pandemic.MethodsThis is a retrospective study with a chart review of patients (<20 years old) with symptomatic gallstone disease and with ultrasound findings of calculous cholecystitis admitted in the past 12 months (January to December 2021) at a primary government hospital in the province of Rizal, Philippines.ResultsA total number of 15 admissions (January to December 2021) were noted from a previous 5 admissions pre-COVID-19 pandemic (January to December 2019), an increase in the trend of those below 20 years old with symptomatic gallstone disease requiring hospitalization before the COVID-19 pandemic. The increase in the disease and hospitalization were more common in females and overweight patients.ConclusionsThis study validated the observation of the authors that there is an increase in the number of patients below 20 years old of age hospitalized for symptomatic gallstone disease during the COVID-19 pandemic in the province of Rizal (San Mateo & Rodriguez), Philippines. The uptrend is due to risk factors such as early pregnancy, obesity, and physical inactivity and may be attributed to the implementation of strict community quarantine.

Reducing waiting lists for laparoscopic cholecystectomy: An intensive approach to aid COVID-19 recovery.

Background: Laparoscopic cholecystectomy is one of the most frequently performed operations in the United Kingdom, commonly due to symptomatic gallstones. Delay between diagnosis and definitive surgical intervention often leads to a significant readmission rate, growing financial burden and increased complexity of the ultimate surgical intervention. Resource reallocation and reduced operational capacity during the coronavirus disease 2019 (COVID-19) pandemic has led to an impending waiting list crisis. Methods: In an attempt to address the backlog of cases, five intensive dedicated operating lists were allocated for laparoscopic cholecystectomies across a weekend in October 2020 at a single Trust. Prospective data were collected to include baseline demographics, operative procedure, 30-day post-operative outcomes and financial implications. Results: A total of 21 cholecystectomies were performed in total, with a majority ASA 2 (American Society of Anaesthesiologists) for predominantly biliary colic indication. All were completed laparoscopically, with a 90.5% rate for complete resection. There were no reported on-table complications and 81.0% of patients discharged as a day case. Thirty day follow-up revealed a complication rate of 9.5%, with 2 patients requiring oral antibiotics for a superficial wound infection. The 30 day COVID-19 rate was 14.3%. Compared to completion on an average weekday list, the total weekend was estimated to have saved over £70,000 in overall costs. Conclusion: Our study showed that weekend focused operating, with a caveat of careful patient selection and high-quality multidisciplinary working, can be a feasible solution to long waiting lists due to COVID-19 pandemic. It was safe, with avoidance of increased burden on emergency resources, and significantly increased theatre efficiency.

Long-term effects of appendectomy in humans: is it the optimal management of appendicitis?

INTRODUCTION: Appendectomy remains the gold standard for treating uncomplicated and complicated appendicitis. However, the vermiform appendix may play a significant role in the immune system (secondary immune function) and maintain a reservoir of the normal microbiome for the human body. The aim of this study was to summarize the long-term effects after appendectomy and discuss whether appendectomy is suitable for all appendicitis patients. AREAS COVERED: A comprehensive and unbiased literature search was performed in PubMed. The terms 'appendix,' 'appendicitis,' 'appendectomy,' and 'endoscopic retrograde appendicitis therapy' were searched in the title and/or abstract. This review summarizes the long-term effects of appendectomy on some diseases in humans and describes three methods including appendectomy, medical treatment, and an 'organ-sparing' technique, named endoscopic retrograde appendicitis therapy (ERAT) to treat appendicitis. EXPERT OPINION: Appendectomy remains the first-line therapy for appendicitis. The patient's problem is appendix, not appendicitis. If we treat appendicitis, the problem should be resolved. During COVID-19, an initial antibiotic treatment of mild appendicitis represents a promising strategy. For patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment, or ERAT could be proposed.

Thoracic empyema after gallstone spillage in times of Covid.

INTRODUCTION: Laparoscopic cholecystectomy has become the gold standard for gallbladder disease. Although gallbladder perforation and spilled gallstones during surgery are common complications, thoracic consequences are rare. PRESENTATION OF CASE: We describe a case of a pleural empyema developed in an immunosuppressed patient five months after laparoscopic cholecystectomy, as a result of spilled gallstones. Decortication via video assisted thoracoscopy resulted in retrieval of stone remnants, biliary sludge and diagnosis of a diaphragmatic defect. DISCUSSION: Iatrogenic perforation of the gallbladder is the most common complication after laparoscopic cholecystectomy. Despite this, thoracic consequences derived from spilled gallstones are rare, but they represent significant morbidity. CONCLUSION: Thoracic complications after spilled gallstones are rare. Documentation of iatrogenic perforation of the gallbladder and a high index of suspicious are fundamental to speed diagnosis and treatment.