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Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Number 07

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Ginecol Obstet Mex 2023; 91 (07)

Acute cholecystitis associated with severe COVID-19 in pregnancy. Case report and bibliographic review

Barbabosa VJA, Rafaelano MAJ, Guerra AMR, Castillo CJR, Zaldívar ELV

Language: Spanish
References: 62
Page: 534-548
PDF size: 1028.35 Kb.


ABSTRACT

Background: Pregnant women infected with SARS-CoV-2 were 2.9 times more likely to require invasive ventilation. Acute cholecystitis is the second most common surgical indication in pregnancy. In the literature search, no reports of concomitance of both diseases during pregnancy were found, for this reason the clinical case report is published and the literature is reviewed.
Case Report: 32-year-old female patient, in the course of 23 weeks of pregnancy. Due to symptoms of COVID-19, with positive PCR test, she was hospitalized for initiation of invasive mechanical ventilation. On the ninth day of hospitalization, she had elevated transaminases and CT report of acute cholecystitis alliasis. Percutaneous cholecystostomy was indicated, which relieved the hepatobiliary symptoms. In the second surgical stage, a cesarean section was performed. Three days later she experienced gradual ventilatory and biochemical improvement. After 32 days of hospitalization, intubation was achieved and, after 54 days, she was discharged from the hospital, without requiring supplemental oxygen.
Conclusions: Finding, in conjunction with severe COVID-19 acute respiratory failure syndrome requiring invasive mechanical ventilation, pre-viable pregnancy, alliasic cholecystitis, places the pregnant woman and the medical team in serious medical, surgical, and bioethical dilemmas. Percutaneous cholecystostomy in patients with hemodynamic instability and termination of pregnancy in case of ventilatory deterioration in the face of acute respiratory failure syndrome is a controversial option. Evidence-based procedures and multidisciplinary sessions, including the family, are undoubtedly conducive.


REFERENCES

  1. Ren LL, Wang YM, Wu ZQ, et al. Identification of a novelcoronavirus causing severe pneumonia in human: a descriptivestudy. Chin Med J (Engl) 2020; 133 (9): 1015-24.doi: 10.1097/CM9.0000000000000722

  2. Suárez V, Suarez Quezada M, Oros Ruiz S, Ronquillo DeJesús E. Epidemiología de COVID-19 en México: del 27 defebrero al 30 de abril de 2020. Rev Clin Esp 2020; 220 (8):463-71. doi: 10.1016/j.rce.2020.05.007

  3. WHO Director-General's opening remarks at the mediabriefing on COVID-19 - 11 March 2020. https://www.who.int/director-general/speeches/detail/who-directorgeneral-s-opening-remarks-at-the-media-briefing-oncovid-19---11-march-2020

  4. Informe Semanal de Vigilancia Epidemiológica. Semana

  5. Dirección General de Epidemiología Secretaría deSalúd. México, 2019. https://www.gob.mx/cms/uploads/attachment/file/521458/MM_2019_SE52.pdf5. Informe Semanal de Vigilancia Epidemiológica. Semana53. Dirección General de Epidemiología Secretaría deSalúd. México, 2020. https://www.gob.mx/cms/uploads/attachment/file/604103/MMAT_2020_SE53.pdf

  6. Informe Semanal de Vigilancia Epidemiológica. Semana52. Dirección General de Epidemiología Secretaría deSalúd. México (2021). https://www.gob.mx/cms/uploads/attachment/file/690500/MM_2021_SE52.pdf

  7. Thompson JL, Nguyen LM, Noble KN, Aronoff DM. COVID-19-related disease severity in pregnancy. Am J ReprodImmunol 2020; 84 (5): e13339. doi: 10.1111/aji.13339

  8. Jamieson DJ, Rasmussen SA. An update on COVID-19 andpregnancy. Am J Obstet Gynecol 2022; 226: 177-86. doi:10.1016/j.ajog.2021.08.054

  9. Ko JY, DeSisto CL, Simeone RM, et al. Adverse pregnancyoutcomes, maternal complications, and severe illnessamong US delivery hospitalizations with and without acoronavirus disease 2019 (COVID-19) diagnosis. Clin InfectDis 2021; 73 (Suppl 1): S24-S31. doi: 10.1093/cid/ciab344

  10. Villar J, Ariff S, Gunier RB, et al. Maternal and neonatalmorbidity and mortality among pregnant women withand without COVID-19 infection: the INTERCOVID multinationalcohort study. JAMA Pediatr 2021; 175: 817-26.doi:10.1001/jamapediatrics.2021.1050

  11. Weinstein M, Feuerwerker S, Baxter J. Appendicitis andCholecystitis in Pregnancy. Clin Obstet Gynecol 2020; 63(2): 405-15. doi: 10.1097/GRF.0000000000000529

  12. Jorge AM, Keswani RN, Veerappan A, et al. Non-operativemanagement of symptomatic cholelithiasis in pregnancyis associated with frequent hospitalizations. J GastrointestSurg 2015; 19: 598-603. doi: 10.1007/s11605-015-2757-8

  13. Lanzafame RJ. Cholelithiasis, cholecystitis, and cholecystodochotomyduring pregnancy. In: Nezhat C, Kavic M,Lanzafame R, Lindsay M, Polk T. (eds) Non-Obstetric SurgeryDuring Pregnancy. Springer, 2019; Cham. doi: 10.1007/978-3-319-90752-9_11

  14. Singh R, Domenico C, Rao SR. Novel coronavirus disease2019 in a patient on durable left ventricular assist devicesupport. J Card Fail 2019; 26: 438-39. doi: 10.1016/j.cardfail.2020.04.007

  15. Roy J, Sahu N, Golamari R, Vunnam R. Acute acalculouscholecystitis in a patient with COVID-19 and a LVAD. J CardFail 2020; 26 (7): 639. doi: 10.1016/j.cardfail.2020.06.002

  16. Ying M, Lu B, Pan J, Lu G, Zhou S, Wang D, Li L, Shen J, ShuJ; From the COVID-19 Investigating and Research Team. COVID-19 with acute cholecystitis: a case report. BMC InfectDis 2020; 20 (1): 437. doi: 10.1186/s12879-020-05164-7

  17. Bruni A, Garofalo E, Zuccalà V, Currò G, Torti C, NavarraG, De Sarro G, Navalesi P, Longhini F, Ammendola M.Histopathological findings in a COVID-19 patient affectedby ischemic gangrenous cholecystitis. World J Emerg Surg2020; 15 (1): 43. doi: 10.1186/s13017-020-00320-5

  18. Balaphas A, Gkoufa K, Meyer J, Peloso A, Bornand A, McKeeTA, Toso C, Popeskou SG. COVID-19 can mimic acute cholecystitisand is associated with the presence of viral RNA inthe gallbladder wall. J Hepatol 2020; 73 (6): 1566-68. doi:10.1016/j.jhep.2020.08.020

  19. Polk C, Sampson MM, Jacobs A, Kooken B, Ludden T,Passaretti CL, Leonard M. Cholecystitis as a Possible ImmunologicConsequence of COVID-19; Case Series froma Large Healthcare System. Am J Med Sci 2022; 363 (5):456-58. doi: 10.1016/j.amjms.2022.01.008

  20. Hershkovitz Y, Zmora O, Nativ H, Ashkenazi I, HammerschlagJ, Jeroukhimov I. Clinical presentation of acute cholecystitisduring the COVID-19 outbreak. Isr Med Assoc J 2022; 24 (5):306-309. PMID: 35598054. ID: covidwho-1857264 https://www.ima.org.il/MedicineIMAJ/viewarticle.aspx?year=2022&month=05&page=306

  21. Akyürek N, Salman B, Yüksel O, Tezcaner T, et al. Managementof acute calculous cholecystitis in high-riskpatients: percutaneous cholecystostomy followed byearly laparoscopic cholecystectomy. Surg Laparosc EndoscPercutan Tech 2005; 15 (6): 315-20. doi: 10.1097/01.sle.0000191619.02145.c0

  22. Okamoto K, Suzuki T, Takada M, et al. Tokyo Guidelines2018: Flowchart for the management of acute cholecystitisJ Hepatobiliary Pancreat Sci 2018; 25 (1): 55-72.doi:10.1002/jhbp.516

  23. Morales-Maza J, Rodríguez-Quintero JH, et al. Percutaneouscholecystostomy as treatment for acute cholecystitis:What has happened over the last five years? Aliterature review. Rev Gastroenterol Mex (Engl Ed) 2019;84 (4): 482-91. doi:10.1016/j.rgmx.2019.06.004

  24. Madhusudhan KS, Gamanagatti S, Srivastava DN, et al.Radiological interventions in malignant biliary obstruction.World J Radiol 2016; 8 (5): 518-29. doi:10.4329/wjr.v8.i5.518

  25. Venara A, V. Carretier, J. Lebigot, et al. Technique andindications of percutaneous cholecystostomy in the managementof cholecystitis in 2014. J Visc Surg 2014; 151 (6):435-9. doi: 10.1016/j.jviscsurg.2014.06.003

  26. Simorov A, A. Ranade, J. Parcells, et al. Emergent cholecystostomyis superior to open cholecystectomy in extremelyill patients with acalculous cholecystitis: A large multicenteroutcome study. Am J Surg. 2013; 206 (6): 935-40. doi:10.1016/j.amjsurg.2013.08.019

  27. Ambe PC, Kaptanis S, Papadakis M, et al. The treatmentof critically Ill patients with acute cholecystitis. DtschArztebl Int 2016; 113 (33-34): 545-51. doi: 10.3238/arztebl.2016.0545.

  28. Kortram K, van Ramshorst B, Bollen TL, et al. Acutecholecystitis in high-risk surgical patients: percutaneouscholecystostomy versus laparoscopic cholecystectomy(CHOCOLATE trial): study protocol for a randomized controlled.Trials 2012; 13: 7. doi: 10.1186/1745-6215-13-7

  29. Chiappetta Porras LT, Nápoli ED, Canullán CM, et al.Minimally invasive management of acute biliary tractdisease during pregnancy. HPB Surg 2009; 2009: 829020.doi:10.1155/2009/829020

  30. Allmendinger N, Hallisey MJ, Ohki SK, Straub JJ. Percutaneouscholecystostomy treatment of acute cholecystitis inpregnancy. Obstet Gynecol 1995; 86 (4 Pt 2): 653-4. doi:10.1016/0029-7844(95)00087-8

  31. Donders F., Lonnee-Hoffmann R., Tsiakalos A., et al. ISIDOGrecommendations Concerning COVID-19 and pregnancy.Diagnostics (Basel) 2020; 10 (4) 243. doi: 10.3390/diagnostics10040243

  32. Medina Gamero AR, Regalado Chamorro ME, Rosario PacahualaEA. Síndrome de distrés respiratorio agudo en los pacientescon la COVID-19. Atención Primaria Práctica 2021;3 (4): 100097. Spanish. doi:10.1016/j.appr.2021.100097

  33. Lapinsky, SE. Management of acute respiratory failure inpregnancy. Semin Respir Crit Care Med 2017; 38 (2): 201-7.doi:10.1055/s-0037-1600909

  34. Halscott TV, Vaught JJ, and the SMFM COVID-19 Task Force.Management considerations for pregnant patients withCOVID-19. 2020. https://s3.amazonaws.com/cdn.smfm.org/media/2334/SMFM_COVID_Management_of_COVID_pos_preg_patients_4-29-20_final.pdf

  35. Schwaiberger D, Karcz M, Menk M, et al. Respiratoryfailure, and mechanical ventilation in the pregnant patient.Crit Care Clin 2016; 32 (1): 85-95. doi: 10.1016/j.ccc.2015.08.001

  36. Devlin JW, Skrobik Y, Gelinas C, et al. Clinical practiceguidelines for the prevention and management of pain,agitation/sedation, delirium, immobility, and sleep disruptionin adult patients in the ICU. Crit Care Med 2018;46 (9): e825-e873. doi:10.1097/CCM.0000000000003299

  37. Oxford-Horrey C, Savage M, Prabhu M, et al. Putting it allTogether: clinical considerations in the care of critically illobstetric patients with COVID-19. Am J Perinatol 2020; 37(10): 1044-51. doi: 10.1055/s-0040-1713121

  38. Pacheco LD, Saade GR, Hankins GD. Mechanical ventilationduring pregnancy: sedation, analgesia, andparalysis. Am J Perinatol 2020; 37 (10): 1044-51.doi:10.1055/s-0040-1713121

  39. Guérin C, Reignier J, Richard JC, et al. PROSEVA StudyGroup. Prone positioning in severe acute respiratorydistress syndrome. N Engl J Med 2013; 368 (23): 2159-68.doi:10.1056/NEJMoa1214103

  40. Alhazzani W, Møller MH, Arabi YM, et al. Surviving SepsisCampaign: Guidelines on the Management of CriticallyIll Adults with Coronavirus Disease 2019 (COVID-19).Crit Care Med 2020; 48 (6): e440-e469. doi:10.1097/CCM.0000000000004363.

  41. Schnettler WT, Al Ahwel Y, Suhag A. Severe acute respiratorydistress syndrome in coronavirus disease 2019-infectedpregnancy: obstetric and intensive care considerations.Am J Obstet Gynecol MFM 2020; 2 (3): 100120.doi:10.1016/j.ajogmf.2020.100120

  42. Vibert F, Kretz M, Thuet V, et al. Prone positioning andhigh-flow oxygen improved respiratory function in a25-week pregnant woman with COVID-19. Eur J ObstetGynecol Reprod Biol 2020; 250: 257-58. doi:10.1016/j.ejogrb.2020.05.022

  43. Tolcher MC, McKinney JR, Eppes CS, et al. Prone positioningfor pregnant women with hypoxemia due to coronavirusdisease 2019 (COVID-19). Obstet Gynecol 2020; 136 (2):259-61. doi:10.1097/AOG.0000000000004012.

  44. Safaee Fakhr B, Wiegand SB, Pinciroli R, et al. High concentrationsof nitric oxide inhalation therapy in pregnantpatients with severe coronavirus disease 2019 (COVID-19).Obstet Gynecol 2020; 136 (6): 1109-13. doi: 10.1097/AOG.0000000000004128

  45. Valsecchi C, Winterton D, Safaee Fakhr B, et al; DELiverly oFiNO (DELFiNO) Network Collaborators. High-dose inhalednitric oxide for the treatment of spontaneously breathingpregnant patients with severe coronavirus disease 2019(COVID-19) Pneumonia. Obstet Gynecol 2022; 140 (2):195-203. doi: 10.1097/AOG.0000000000004847

  46. Naoum EE, Chalupka A, Haft J, MacEachern M, et al. Extracorporeallife support in pregnancy: a systematic review.J Am Heart Assoc 2020; 9 (13): e016072. doi:10.1161/JAHA.119.016072

  47. Hou L, Li M, Guo K, et al. First successful treatment of aCOVID-19 pregnant woman with severe ARDS by combiningearly mechanical ventilation and ECMO. Heart Lung 2021;50 (1): 33-36. doi:10.1016/j.hrtlng.2020.08.015

  48. Larson SB, Watson SN, Eberlein M, et al. Survival of pregnantcoronavirus patient on extracorporeal membraneoxygenation. Ann Thorac Surg 2021; 111 (3): e151-e152.doi:10.1016/j.athoracsur.2020.09.004

  49. Barrantes JH, Ortoleva J, O'Neil ER, et al. SuccessfulTreatment of pregnant and postpartum women withsevere Covid-19 associated acute respiratory distresssyndrome with extracorporeal membrane oxygenation.ASAIO J. 2021;67(2):132-136. doi: 10.1097/MAT.0000000000001357.

  50. Clemenza S, Zullino S, Vacca C, et al. Perinatal outcomesof pregnant women with severe COVID-19 requiring extracorporealmembrane oxygenation (ECMO): a case seriesand literature review. Arch Gynecol Obstet 2022; 305 (5):1135-42. doi: 10.1007/s00404-022-06479-3

  51. Levitus M, Shainker SA, Colvin M. COVID-19 in the CriticallyIll Pregnant Patient. Crit Care Clin 2022; 38 (3): 521-34. doi:10.1016/j.ccc.2022.01.003

  52. 52 ACOG Practice Bulletin No. 106: Intrapartum fetal heartrate monitoring: nomenclature, interpretation, and generalmanagement principles. Obstet Gynecol 2009; 114 (1):192-202. doi: 10.1097/AOG.0b013e3181aef106

  53. Poon LC, Yang H, Kapur A, Melamed N, et al. Global interimguidance on coronavirus disease 2019 (COVID-19) duringpregnancy and puerperium from FIGO and allied partners:Information for healthcare professionals. Int J GynaecolObstet 2020; 149 (3): 273-86. doi: 10.1002/ijgo.13156

  54. Rose CH, Wyatt MA, Narang K, et al. Timing of delivery withcoronavirus disease 2019 pneumonia requiring intensivecare unit admission. Am J Obstet Gynecol MFM 2021; 3 (4):100373. doi: 10.1016/j.ajogmf.2021.100373

  55. Yu N, Li W, Kang Q, Xiong Z, et al. Clinical features andobstetric and neonatal outcomes of pregnant patients withCOVID-19 in Wuhan, China: a retrospective, single-centre,descriptive study. Lancet Infect Dis 2020; 20 (5): 559-64.doi: 10.1016/S1473-3099(20)30176-6.

  56. Chen R, Zhang Y, Huang L, et al. Safety and efficacy of differentanesthetic regimens for parturients with COVID-19undergoing Cesarean delivery: a case series of 17 patients.Can J Anaesth. 2020;67(6):655-663. doi: 10.1007/s12630-020-01630-7.

  57. Chen S, Liao E, Cao D, et al. Clinical analysis of pregnantwomen with 2019 novel coronavirus pneumonia. J MedVirol 2020; 92 (9): 1556-61. doi:10.1002/jmv.25789

  58. Morau E, Bouvet L, Keita H, et al. Anaesthesia and intensivecare in obstetrics during the COVID-19 pandemic. AnaesthCrit Care Pain Med 2020; 39 (3): 345-349. doi:10.1016/j.accpm.2020.05.006

  59. Tomlinson MW, Caruthers TJ, Whitty JE, Gonik B. Doesdelivery improve maternal condition in the respiratorycompromisedgravida? Obstet Gynecol 1998; 91 (1): 108-11. doi:10.1016/s0029-7844(97)00585-1

  60. Lapinsky SE, Rojas-Suarez JA, Crozier TM, et al. Mechanicalventilation in critically ill pregnant women: a case series.Int J Obstet Anesth 2015; 24 (4): 323-8. doi:10.1016/j.ijoa.2015.06.009

  61. Liu C, Sun W, Wang C, Liu F, Zhou M. Delivery during extracorporealmembrane oxygenation (ECMO) support ofpregnant woman with severe respiratory distress syndromecaused by influenza: a case report and review of the literature.J Matern Fetal Neonatal Med 2019; 32 (15): 2570-74.doi:10.1080/14767058.2018.1439471

  62. Oxford CM, Ludmir J. Trauma in pregnancy. ClinObstet Gynecol 2009; 52 (4): 611-29. doi: 10.1097/GRF.0b013e3181c11edf




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