Percutaneous cholecystostomy in the treatment of acute calculous cholecystitis in elderly patients with covid-19 and high comorbidity

Abstract

BACKGROUND: The purpose of the study was to review the efficacy, safety, and outcomes of percutaneous cholecystostomy (PC) in elderly patients with acute calculous cholecystitis (ACC), high comorbidity, and COVID-19. METHODS: The hospital registry data were examined of patients aged >65 years who were diagnosed with ACC and COVID-19 between March 2020 and June 2020 and who underwent PC treatment in the interventional radiology unit. RESULTS: A total of 18 patients were diagnosed with ACC and COVID-19, then underwent PC. The patients comprised 14 (78%) males and 4 (22%) females with an average age of 73.4 years (range, 67–81 years). In 17 (94%) patients, symptoms associated with acute cholecystitis decreased within 48–72 h of the PC treatment and a clinical improvement was determined. The success rate of PC was 100% and no complications. In 3 (16.6%) patients followed up with intubation in intensive care after the procedure, mortality developed due to COVID-19-associated pneumonia and subsequent acute respiratory distress syndrome, and 15 (83.4%) patients were discharged with an elective cholecystectomy plan. CONCLUSION: COVID-19 infection can be fatal especially in patients over 65 years of age due to additional comorbidities. PC treatment, which can be performed under local anesthesia as a minimally invasive procedure, is an alternative treatment option in this patient group. PC can also act as a bridge in transition to elective surgery in this process management.