Clinical approach to patients admitted to the emergency room due to acute cholecystitis during the COVID-19 pandemic and percutaneous cholecystostomy experience.

BACKGROUND: Acute cholecystitis (AC), a common complication of gallstones, is responsible for a significant part of emergency applications, and cholecystectomy is the only definitive treatment method for AC. Early cholecystectomy has many reported advantages. Operation-related morbidity and mortality have increased during the COVID-19 pandemic. In this study, our aim is to present our general clinical approach to patients who were diagnosed with AC during the pandemic and our percutaneous cholecystostomy experience during this period. METHODS: This study included 72 patients who were presented to our hospital's emergency room between March 11 and May 31, 2020, with AC. Patients were divided into three groups based on their treatment: outpatients (Group 1), inpatients (Group 2) and patients undergoing percutaneous cholecystostomy (Group 3). These three groups were compared by their demographic and clinical characteristics. RESULTS: There were 36 (50%) patients in Group 1, 25 (34.7%) patients in Group 2, and 11 (15.3%) patients in Group 3. The demographic characteristics of the patients were similar. The CRP and WBC levels of the patients in Group 3 were significantly higher compared to the other groups. Moreover, the wall of the gallbladder was thicker and the size of the gallbladder was larger in Group 3. Patients had percutaneous cholecystostomy at the median of 3.5 days and the length of hospital stay was longer compared to Group 2 (3.9 days versus 9.2 days, p=0.00). The rate of re-hospitalization after discharge was similar in Group 2 and Group 3, but none of the patients in Group 1 required hospitalization. None of 72 patients developed an emergency condition requiring surgery, and there was no death. CONCLUSION: Although many publications emphasize that laparoscopic cholecystectomy (LC) can be performed with low morbidity at the first admission in acute cholecystitis, it is a clinical condition that can be delayed in the COVID-19 pandemic and other similar emergencies. Thus, percutaneous cholecystostomy should be effectively employed, and its indications should be extended if necessary (e.g., younger patients, patients with lower CCI or ASA). This approach may enable us to protect both patients and healthcare professionals that perform the operation from the risk of COVID-19.

Scar Endometrioma: An Uncommon Yet Easily Treated Condition.

OBJECTIVE: To illustrate and emphasize the need for keeping scar endometrioma in mind in order to facilitate an early diagnosis in cases of a mass detected on the abdominal wall in women who have undergone a cesarean section. STUDY DESIGN: Records of 21 patients were reviewed retrospectively. All the patients complained of a mass on the abdominal wall and had undergone cesarean section in the past. Endometrioma was confirmed histopathologically for each patient. Information about the characteristics of the patients are retrieved from the patient records and analyzed. RESULTS: The average age of patients was 31 years. The average duration before onset of the complaints in the postcesarean section period was 32.9 months, and the average duration of the complaints was 25.3 months. In most cases (62%) the scar endometrioma was located at the right end of the Pfannenstiel incision. The average size of the endometrioma masses was 30 mm. Recurrence was not observed in any of the patients during an average follow-up of 31.3 months after total excision. CONCLUSION: Scar endometrioma is a rare disease which can be treated easily. If a mass on a cesarean section scar which becomes sensitive during menstruation is detected in a patient with history of cesarean section, the diagnosis of scar endometrioma should be suspected.