ABSTRACT
BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.
Subject(s)
COVID-19 , Cholecystitis, Acute , Cholecystitis , Sepsis , Male , Humans , Middle Aged , Female , Pandemics , SARS-CoV-2 , COVID-19/epidemiology , Cholecystitis/epidemiology , Cholecystitis/surgery , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Postoperative Complications/epidemiologyABSTRACT
UNLABELLED: The authors report a case of intra-abdominal synovial-sarcoma of the gastrocolic ligament in a 64-years-old woman hospitalized for a palpable abdominal mass and pain. CT scan detected an intra-abdominal mass extended through the abdominal wall into the soft tissues, causing compression and dislocation of intra-abdominal structures (left liver, gallbladder, pylorus and gastric antrum, duodenal bulb). At its back, it was in contact with the pancreas, the vena cava and the right kidney. Biopsy revealed that the mass was an intra-abdominal synovial-sarcoma. Patient received preoperative chemotherapy. After three chemotherapy cycles the patient was admitted to hospital for anemia. CT-scan revealed mass necrosis and bleeding. After red blood cells transfusions, the patient underwent surgery and the mass was resected. Histopathological study confirmed the diagnosis of biphasic Synovial-Sarcoma. SYT-SSX1/2 fusion molecular assessment was attempted, but it was not possible to evaluate the presence of the t (X, 18) (p11.2; q11.2) traslocation. The patient was discharged in good health and received adjuvant chemotherapy. CT-scan after 18 months showed pulmonary and intra-abdominal relapse of the disease. KEY WORDS: Gastrocolic ligament, Intra-Abdominal synovial-sarcoma.
Subject(s)
Abdominal Neoplasms , Sarcoma, Synovial , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/surgery , Female , Humans , Middle Aged , Sarcoma, Synovial/diagnosis , Sarcoma, Synovial/surgeryABSTRACT
The authors report a case of intra-abdominal synovial-sarcoma of the gastrocolic ligament in a 64-years-old woman hospitalized for a palpable abdominal mass and pain. CT scan detected an intra-abdominal mass extended through the abdominal wall into the soft tissues, causing compression and dislocation of intra-abdominal structures (left liver, gallbladder, pylorus and gastric antrum, duodenal bulb). At its back, it was in contact with the pancreas, the vena cava and the right kidney. Biopsy revealed that the mass was an intra-abdominal synovial-sarcoma. Patient received preoperative chemotherapy. After three chemotherapy cycles the patient was admitted to hospital for anemia. CT-scan revealed mass necrosis and bleeding. After red blood cells transfusions, the patient underwent surgery and the mass was resected. Histopathological study confirmed the diagnosis of biphasic Synovial-Sarcoma. SYT-SSX1/2 fusion molecular assessment was attempted, but it was not possible to evaluate the presence of the t (X, 18) (p11.2; q11.2) traslocation. The patient was discharged in good health and received adjuvant chemotherapy. CT-scan after 18 months showed pulmonary and intra-abdominal relapse of the disease.
