Acute pancreatitis: an opportunity for gastroenterology hospitalists?

Acute pancreatitis (AP) is the third most frequent cause of hospital admissions for digestive disorders in the US and Europe after digestive bleeding and cholelithiasis/cholecystitis. The incidence of AP ranges from 15 to 100 cases per 100,000 inhabitants per year, and has been steadily increasing in recent years. In Spain, the reported incidence is 72 patients per 100,000 inhabitants per year. The most frequent cause is biliary lithiasis (50 %-60 % of cases); fortunately, 80 % of patients have only mild symptoms-as defined by the revised Atlanta Classification-and progress favorably, although mortality rate is 4.2 %. Clinical guidelines explicitly indicate that laparoscopic cholecystectomy should be performed during the first 48-72 hours or at the time of hospital admission in mild cases of biliary origin.

Impact of the COVID-19 pandemic on the management of gallstone surgery: A Swedish population-based study.

BACKGROUND: The SARS-CoV-2 pandemic has had a significant impact on healthcare delivery. As resources are reallocated, surgery for benign conditions such as gallstone disease is often given low priority. We do not know how this has affected the risk of patients with uncomplicated gallstone disease to develop acute cholecystitis, biliary pancreatitis, or obstructive jaundice. METHODS: The study was based on the population-based Swedish Register of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The period prior to the first cases of COVID-19 in Sweden, that is, April 2015-March 2020, was compared to the period April 2020-March 2021 during the pandemic. Stratification was made for factors potentially related to priority decisions. RESULTS: Altogether, 78,211 procedures were performed during the period of the study. The ratio of procedures performed during April 2020-March 2021 in the previous 5 years was 0.960 (p = 0.113). The ratio of procedures on patients aged <65 years was 0.945 (p = 0.008), on patients aged 65-80 years was 0.964 (p = 0.423), on patients aged >80 years was 1.336 (p = 0.025), on men was 1.001 (p = 0.841), on women was 0.934 (p = 0.006), on procedures completed laparoscopically was 0.964 (p = 0.190), on procedures completed with open approach was 0.659 (p = 0.044), on acute procedures was 1.218 (p = 0.016), on planned procedures was 0.791 (p < 0.001), on procedures performed for biliary colic was 0.808 (p < 0.001), on procedures performed for acute cholecystitis was 1.274 (p = 0.012), for biliary pancreatitis was 1.192 (p = 0.037), and for obstructive jaundice was 1.366 (p = 0.008). CONCLUSIONS: The COVID-19 has had a great impact on how gallstone surgery has been organized over the last 2 years. The decreased number of planned procedures probably reflects the reallocation of resources during the pandemic. However, whether the increasing number of acute procedures is the result of postponed planned surgery or a continuation of a long-term trend toward more acute surgery remains unanswered. Further studies are needed to assess and evaluate how this has affected public health and health economics.

How correct is the postponed cholecystectomy during the coronavirus disease-19 pandemic process? Gallstone ileus is not a myth anymore.

Posponer cirugías electivas durante el proceso pandémico de Covid-19 aumentó el riesgo de complicaciones graves de enfermedades benignas. El íleo biliar es una de las raras complicaciones de la colelitiasis (0,3-0,5%). Los episodios recurrentes de colecistitis aguda están involucrados en la fisiopatología. La demostración de la tríada de Rigler en tomografía computarizada es diagnóstica. Para reducir la morbilidad se recomienda la cirugía dos etapas: extirpar el cálculo por enterotomía en la primera operación, cirugía biliar en la segunda operación. El íleo biliar debe estar en el diagnóstico diferencial de las obstrucciones intestinales mecánicas, especialmente en pacientes con antecedentes de ataques de colecistitis durante el proceso pandémico de Covid-19 porque las cirugías electivas se detuvieron.Postponing elective surgeries during the coronavirus disease-19 (COVID-19) pandemic process increased the risk of severe complications of benign diseases. Gallstone ileus is one of the rare complications of cholelithiasis (0.3-0.5%). Recurrent episodes of acute cholecystitis are involved in pathophysiology. Demonstration of Rigler's triad on computed tomography is diagnostic. To reduce morbidity stepped surgery is recommended: remove the stone by enterotomy at the first operation and biliary surgery at the second operation. Gallstone ileus should be in the differential diagnosis of mechanical intestinal obstructions, especially in patients with a history of cholecystitis attacks during the COVID-19 pandemic process because elective surgeries stopped.

Bouveret syndrome: a clinicoradiological perspective.

An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.