Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4908-4916
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4908
Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis: A case report and literature review
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
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, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Fang Wu, Department of Pathology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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. See: http://creativecommons.org/licenses/by-nc/4.0/
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@mail.tsinghua.edu.cn
Received: June 8, 2020
Peer-review started: June 8, 2020
First decision: August 22, 2020
Revised: August 24, 2020
Accepted: September 11, 2020
Article in press: September 11, 2020
Published online: October 26, 2020
Processing time: 139 Days and 20 Hours
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.

Keywords: Extremely elderly patient; Cholecystolithiasis incarceration; Acute gangrenous cholecystitis; Acute abdominal diseases; COVID-19; Case report

Core Tip: We report the therapeutic experience of an 89-year-old high-risk patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. This paper explores the indication for emergency surgery, selection of surgical procedure, and maintenance of postoperative cardiopulmonary function, so as to provide beneficial reference for emergency surgery in elderly patients with high-risk acute abdominal diseases.