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      Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis: A case report and literature review

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          Abstract

          BACKGROUND

          The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases. Elderly patients are a high-risk group for surgical treatment. If the incarceration of gallstones cannot be relieved, emergency surgery is unavoidable.

          CASE SUMMARY

          We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. He had several coexisting, high-risk underlying diseases, had a history of radical gastrectomy for gastric cancer, and was taking aspirin before the operation. Nevertheless, he underwent emergency laparoscopic cholecystectomy, with maintenance of postoperative heart and lung function, successfully recovered, and was discharged on day 8 after the operation.

          CONCLUSION

          Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic, the key is to abide strictly by the hospital’s epidemic prevention regulations, fully implement the epidemic prevention procedure for emergency surgery, fully prepare before the operation, accurately perform the operation, and carefully manage the patient postoperatively.

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          Most cited references31

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          The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak

          Hussin A Rothan, Siddappa Byrareddy (2020)
          Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
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            Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients

            Randy Wax, Michael D Christian (2020)
            A global health emergency has been declared by the World Health Organization as the 2019-nCoV outbreak spreads across the world, with confirmed patients in Canada. Patients infected with 2019-nCoV are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to healthcare workers providing care. Although the exact mechanisms of transmission are currently unclear, human-to-human transmission can occur, and the risk of airborne spread during aerosol-generating medical procedures remains a concern in specific circumstances. This paper summarizes important considerations regarding patient screening, environmental controls, personal protective equipment, resuscitation measures (including intubation), and critical care unit operations planning as we prepare for the possibility of new imported cases or local outbreaks of 2019-nCoV. Although understanding of the 2019-nCoV virus is evolving, lessons learned from prior infectious disease challenges such as Severe Acute Respiratory Syndrome will hopefully improve our state of readiness regardless of the number of cases we eventually manage in Canada.
            Article 0 comments Cited 473 times – based on 0 reviews     Review now
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              Aspirin in Patients Undergoing Noncardiac Surgery

              P.J. Devereaux, Marko Mrkobrada, Daniel Sessler … (2014)
              There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P=0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P=0.04). The primary and secondary outcome results were similar in the two aspirin strata. Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).
              Article 0 comments Cited 177 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Zong-Ming Zhang
                Chong Zhang
                Zhuo Liu
                Li-Min Liu
                Ming-Wen Zhu
                Yue Zhao
                Bai-Jiang Wan
                Hai Deng
                Hai-Yan Yang
                Jia-Hong Liao
                Hong-Yan Zhu
                Xue Wen
                Li-Li Liu
                Man Wang
                Xiao-Ting Ma
                Miao-Miao Zhang
                Jiao-Jiao Liu
                Tian-Tian Liu
                Niu-Niu Huang
                Pei-Ying Yuan
                Yu-Jiao Gao
                Jing Zhao
                Xi-Ai Guo
                Fang Liao
                Feng-Yuan Li
                Xue-Ting Wang
                Rui-Jiao Yuan
                Fang Wu
                Journal
                Journal ID (nlm-ta): World J Clin Cases
                Journal ID (publisher-id): WJCC
                Title: World Journal of Clinical Cases
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2307-8960
                Publication date (Print): 26 October 2020
                Publication date (Electronic): 26 October 2020
                Volume: 8
                Issue: 20
                Pages: 4908-4916
                Affiliations
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China. zhangzongming@ 123456mail.tsinghua.edu.cn
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Department of Pathology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
                Author notes

                Author contributions: All authors contributed to this paper; Zhang ZM, Zhang C, Liu Z, Liu LM, Zhu MW, Zhao Y, Wan BJ, Deng H, Yang HY, Liao JH, Zhu HY, Wen X, Liu LL, Wang M, Ma XT, Zhang MM, Liu JJ, Liu TT, Huang NN, Yuan PY, Gao YJ, Zhao J, Guo XA, Liao F, Li FY, Wang XT, and Yuan RJ performed the diagnosis and treatment; Wu F performed the pathological examination; Zhang ZM and Zhang C were major contributors in the writing of this manuscript; Zhang ZM provided the funding; All authors have read and approved the final version of the manuscript.

                Supported by Beijing Municipal Science and Technology Commission, No. Z171100000417056.

                Corresponding author: Zong-Ming Zhang, MD, PhD, Chief Doctor, Professor, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, No. 1 Taipingqiaoxili, Fengtai District, Beijing 100073, China. zhangzongming@ 123456mail.tsinghua.edu.cn

                Article
                Other ID: jWJCC.v8.i20.pg4908
                DOI: 10.12998/wjcc.v8.i20.4908
                PMC ID: 7642542
                PubMed ID: 33195660
                SO-VID: 85574b67-6b5a-4205-a1dd-1bb3be99d8e3
                Copyright © ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 8 June 2020
                Date revision received : 24 August 2020
                Date accepted : 11 September 2020
                Categories
                Subject: Case Report

                Keywords: extremely elderly patient,cholecystolithiasis incarceration,acute gangrenous cholecystitis,acute abdominal diseases,covid-19,case report
                Data availability:
                Keywords: extremely elderly patient, cholecystolithiasis incarceration, acute gangrenous cholecystitis, acute abdominal diseases, covid-19, case report

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