Clinical features and outcomes of patients with severe acute pancreatitis complicated with gangrenous cholecystitis

BACKGROUND: The effects of gangrenous cholecystitis (GC) and consequent surgical interventions on the clinical outcomes and prognosis of patients with severe acute pancreatitis are not clear. The present study was to characterize the clinical outcomes of patients with severe acute pancreatitis complicated with GC. METHODS: We retrospectively analyzed 253 consecutive patients hospitalized for acute pancreatitis in intensive care unit. Among them, 68 were diagnosed as having severe acute pancreatitis; 10 out of the 68 patients had GC. We compared these 10 patients with GC and 58 patients without GC. The indices analyzed included sepsis/septic shock, pancreatic encephalopathy, acute respiratory distress syndrome, acute renal failure, multiple organ dysfunction syndrome, and death. RESULTS: Specific CT images of GC in patients with severe acute pancreatitis included enlarged and high-tensioned gallbladder, wall thickening, lumenal emphysema, discontinuous and/or irregular enhancement of mucosa, and pericholecystic effusion. The rates of severe sepsis/septic shock (70.0% vs 24.1%, P【0.01), pancreatic encephalopathy (50.0% vs 17.2%, P【0.05), acute respiratory distress syndrome (90.0% vs 41.4%, P【0.01), multiple organ dysfunction syndrome (70.0% vs 24.1%, P【0.01), acute renal failure (40.0% vs 27.6%, P【0.05), and death (40.0% vs 13.8%, P【0.05) were significantly higher in patients with GC than in those without GC.CONCLUSION: CT scans can help to identify early GC in patients with severe acute pancreatitis; early diagnosis and intervention for patients with GC can reduce morbidity and mortality.

Gangrenous cholecystitis: A silent but potential fatal disease in patients with diabetic neuropathy. A case report

Gangrenous cholecystitis(GC) is a severe and potentially deadly complication of acute cholecystitis. We present a 83-year-old gentleman with a past medical history of type 2 diabetes mellitus with significant associated neuropathy, presenting to a community hospital in a major metropolitan area with 10 days nausea and vomiting and a benign abdominal exam. While the patient was admitted for hyperglycemia, he was subsequently found to have severe GC requiring urgent surgical intervention.

Laparoscopic cholecystectomy for gangrenous cholecystitis in around nineties: Two case reports

BACKGROUND Gangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alterations in the gallbladder wall and it often follows an acute and serious course.We herein report on two cases of very elderly people diagnosed early with gangrenous cholecystitis,who safely underwent laparoscopic cholecystectomy(LC)and both demonstrated a good outcome.CASE SUMMARY Case 1:An 89-year-old female.She underwent abdominal contrast-enhanced computed tomography(CECT)due to abdominal pain and diarrhea.Her gallbladder wall indicated the absence of contrast enhancement,thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent LC.Although her gallbladder demonstrated diffuse necrosis and it was also partly perforated,she was able to be discharged without any serious complications.Case 2:A 91-year-old female.She made an emergency visit with a chief complaint of abdominal pain.Abdominal CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder wall.She was diagnosed with gangrenous cholecystitis and underwent LC.Her gallbladder had swelling and diffuse necrosis.Although her preoperative blood culture was positive,she showed a good outcome following surgery.CONCLUSION Although a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery,if an early diagnosis can be made and appropriate treatment can be carried out,then even very elderly individuals may be discharged without major complications.

Gangrenous Amyand’s hernia in neonate: A great clinical masquerader

Amyand’s hernia [AH] is a rare condition with presence of vermiform appendix in an inguinal hernia sac [1]. It is a rare entity with very difficult preoperative diagnosis that does not affect management. We herein report a neonatal gangrenous AH masking all features of underlying bowel gangrene. In neonates, a great masquerader can mask all the features of underlying bowel gangrene and delay in diagnosis can be detrimental in context of outcome. A high index of suspicion of Amyand’s hernia with gangrene should be kept even if child presents with irreducible hernia without features of strangulation to prevent avoidable increase in morbidity and mortality.

Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman

In elderly patients, numerous factors subsidize the diagnostic challenge and high incidence of complications in this specific population, taking gangrenous cholecystitis as a critical example. The aim of this work is to report an unusual case of gangrenous choleystitis in an elderly diabetic women and its atypical clinical presentation. A 79-year-old female patient came to our observation;her medical history showed nausea and vomiting of about 2 hours which rapidly ended with symptomatic therapy, without recurrence, and a 3-week history of intermittent fever associated with productive cough. No abdominal discomfort was declared. Physical examination of the abdomen was negative. Laboratory analysis revealed leukocytosis with the remaining criteria within the normal range. After 2 days, she started with a mildabdominal pain in the epigastric region that rapidly progressed to the right upper quadrant, right flank and right iliac fossa, without nausea, vomiting or fever. Abdominal computer tomography findings revealed thickness of the gall-bladder and important densification of the vascular bed. Acute cholecystitis was diagnosed. The patient was then submitted to a laparoscopic cholecystectomy under general anaesthesia with findings suggestive of gangrenous acute cholecystitis confirmed by histologic examination of the specimen. Delays in diagnosing acute cholecystitis in specific populations, such as elderly diabetics, result in a higher prevalence of morbidity and mortality due to potentially serious complications as gangrenous cholecystitis. Consequently, the diagnosis should be measured and investigated promptly in order to prevent poor outcomes.

Intestinal obstruction caused by torsed gangrenous Meckel's diverticulum encircling terminal ileum

Meckel's diverticulum(MD)is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage,obstruction,and inflammation.Obstruction of various types is the most common presenting symptom in the adult population.Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications.The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies.Delay in the diagnosis of a complicated MD can lead to signifi- cant morbidity and mortality.Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum.To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.

Clinical Versus Doppler Based Assessment in Determining Amputation Level in Diabetic Foot Gangrene;A Prospective Cross-Sectional Study at Atbuth, Bauchi

Background: Amputation is defined as the surgical removal of a limb or part of a limb through the bone. If the amputation is done above or below the knee, they are termed major while minor amputations involve the partial removal of foot including forefoot resections, ray amputation of the digits or parts of the digits. Significant number of patients with diabetic foot ulcers end with amputations. In the past the amputation level was decided by clinical assessment alone, such as physical examination using color, temperature, peripheral pulses and wound bleeding during surgical procedure. The use of Doppler ultrasound to measure arterial blood pressure at the proposed amputation site has been advocated as a predictor of amputation success. An optimal choice of the level of amputation can reduce amputation complications. Methodology: A Prospective comparative randomized cross-sectional study carried out between 1st January 2022 and 1st January 2024 in ATBUTH, Bauchi amongst patients with diabetic foot Wagener stage IV and V scheduled for amputation. Outcome measures of wound break down, flap necrosis and re-amputation were assessed amongst the clinical based level assessment group and the doppler based level assessment group. Results: A total of 171 patients were recruited into the study. Males 103 and 68 are females, giving a male to female ratio of 1.5:1. mean age 47 years. There were 84 patients in the clinical based level assessment group and 87 patients in the doppler based level assessment. Conclusion: Diabetes mellitus foot disease is a significant risk factor for non-traumatic lower limb amputation and doppler level assessment is superior to clinical level in determining amputation level among diabetic patients scheduled for amputation. P-value 0.003.

Fournier’s Gangrene: A Review of Fournier’s Gangrene Severity Index (FGSI) and Other Predictors of Mortality

Background: Fournier gangrene is an acute and rapidly progressive necrotizing fasciitis of the scrotum, perianal and perineal region of the body. It is a polymicrobial infection having an interplay of both anaerobic and aerobic orgasms in a soup of microbial disaster. Fournier’s gangrene was also initially thought to be an idiopathic condition but a lot of risk factors have been associated now with this condition, both systemic risk factors and local. Systemic risk factors include diabetes mellitus, HIV/AIDS, cancers, chronic liver disease, chronic steroid use etc. The local risk factors include perineal injuries, watering can perineum, perianal abscess, chronic perineal itching etc. Purpose: The swiftly flourishing bacteria orgasms cause a similar disruptive event in the body of the patients both clinically and biochemically and these can be used to create a predictive score or index for patients in order to assess the disease severity and guide in the management and prognostication of this condition. Materials and Method: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Folders were retrieved and the medical records were reviewed. Results: Of the 50 patients reviewed, Male to female ratio is 24:1. The mean age is 56 years (2 weeks to 97 years). Mortality rate was 34%. There is a significant difference between delayed presentation/initial use of unorthodox treatment with mortality (p = 0.002). Of the 17 patients that died, 15 had FGSI > 9 and of the 33 patients that survived 29 had FGSI 9 is 88.2% while the mortality rate for those with FGSI Conclusion: knowledge of the predictors of its mortality is necessary in other to help stratify patients and ensure the best response by the caregivers. FGSI, delayed presentation/initial patronage of unorthodox care, and polymicrobial infection are important predictors of mortality in this condition.

Fournier’s Gangrene: 13-Year Experience in a Tertiary Center, North Eastern Nigeria

Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .

Gangrene of the External Genitalia at Chu-Abeche

Introduction: Gangrene of the external genitalia organs (EGO) is a medico-surgical emergency that is still very common in Third World countries. The main etiologies are urogenital, dermocutaneous and proctological. Mortality remains very high despite therapeutic advances. Our aim was to report on the epidemiological, diagnostic and therapeutic aspects of gangrene of the external genitalia, and to identify prognostic factors. Patients and Method: This was a 5-year retrospective descriptive study, from February 2016 to February 2021, of cases of gangrene of the external genitalia admitted to and treated in the Urology Department of Abeche University Hospital. Results: We collected 49 cases of gangrene of the external genitalia. The mean age of patients was 42 ± 16.81, with extremes of 20 and 81 years. The age group most concerned was between 20 and 29. The most frequent reasons for consultation were suppuration of the external genitalia and scrotal swelling. The average consultation time was 19.05 ± 16.02 days. The most common comorbidity was diabetes (35.9%). The most frequent pathological antecedents were urinary tract infections and endourethral maneuvers, reported in 40.5% and 38.7% respectively. Urogenital aetiology was predominant in 54.7%, and idiopathic in 35.9%. Lesions involved the scrotum in 60.6%, the scrotum and penis in 16.5%, and the penis alone in 5.7% of cases. Lesions extended to the perineum in 13.6% of cases, and to the abdomen in 3.6%. Vascular filling via the central venous line was performed in 58.6% of cases, and via the peripheral venous line in 41.4%. 3rd-generation cephalosporins and associated imidazoles were the most commonly used antibiotics. Necrosectomy was performed in 37 patients (73.4%), debridement combined with bypass cystostomy in 26.6% of cases. Colostomy was performed in 4% of cases. 90.8% of patients were cured and 9.2% died. The average hospital stay was 30 ± 75 days. Conclusion: The gangrene of the external genitalia is a medical and surgical emergency which has become rare in Europe, but which is still very common in the context of our practice in Chad. The severity of the disease is linked to delayed consultation and co-morbidity factors. Mortality remains very high despite therapeutic advances.

Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier’s Gangrene Severity Index: Analysis of 69 patients

Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.

Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature

BACKGROUND Abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C.perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation,we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained.Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to GuillainBarre syndrome 75 d after the first surgery. This paper presents this case of intraabdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage,appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.

Fournier gangrene in an infant, complicated with severe sepsis and liver dysfunction: A case report

BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.

Fournier’s gangrene after insertion of thermo-expandable prostatic stent for benign prostatic hyperplasia:A case report

BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral stent implantation,minor complications such as urinary tract infection,irritative symptoms,gross hematuria,and urethral pain have been observed;however,there are no reports of life-threatening events.Herein,we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia(volume,126 ccs;as measured by transrectal ultrasound)had undergone insertion of a thermoexpandable urethral stent(Memokath 028)as he was unfit for surgery under general anesthesia.However,the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent(Memokath 028).We had planned to remove the Memokath 028;however,the patient was lost to follow-up.The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area.In digital rectal examination,tenderness and heat of prostate was identified.Also,the black skin color change with foulsmelling from right scrotum to right inguinal area was identified.In computed tomography finding,subcutaneous emphysema was identified to same area.He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings.In emergency room,Fournier’s gangrene severity index value is seven points.Therefore,he underwent emergent extended surgical debridement and removal of the Memokath 028.Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed.However,the patient died 14 days after surgery due to multiorgan failure.CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients,its rapid removal may help prevent severe complications.

Fournier’s Gangrene in a Child Hospitalised in the Paediatric Emergency Department of the Gabriel Touré Teaching Hospital

Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.

One Case of Diabetes Nephropathy Stage V, Combined Valvular Disease, Total Heart Failure with Diabetes Foot Gangrene

The patient was found to have 4+urine sugar by physical examination 14 years ago and was treated with oral hypoglycemic drugs. Insulin was injected intramuscularly nine years ago. Two and a half years ago, it was found that the color of the thumb, index and middle toe of the left foot became black. He went to a third-class hospital in Beijing and was diagnosed as “diabetes foot”. He was treated with “balloon dilation of lower limb blood vessels of diabetes foot”. Half a year ago, the third toe on the right side was broken and treated in the hospital again. “Popliteal artery stent implantation” was given for the diagnosis of “double kidney insufficiency, diabetes foot, left heart failure, combined heart valve disease”, “Hemofiltration therapy” and anti-inflammatory, amino acid supplementation, kidney function protection, anticoagulation, anemia correction and other treatments. Later, he went to our hospital and was diagnosed by the TCM diagnosis: category of consumptive disease, toe or finger gangrene (syndrome/pattern of qi and yin deficiency). Western medicine diagnosed: stage V of diabetes nephropathy, type II diabetes foot gangrene, combined with heart valve disease, hypoalbuminemia, double kidney cyst, moderate anemia, pleural effusion, hyperkalemia, pulmonary infection, and total heart failure. The patient was treated by the Qi-acupuncture therapy of TCM in combination with Chinese and Western medicine Medical treatment made the patient significantly better and discharged.

Continuous Spinal Anesthesia in Precarious Patients: An Experience in Lubumbashi DR Congo

Background: Continuous spinal anesthesia (CSA) is an underused technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia (SSA) usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. It is indicated in elderly patients undergoing lower limbs and sub umbilical surgery. Aim: This work aims to highlight the advantages of CSA on hemodynamic stability and as an alternative to heavy anesthetic procedures in already fragile patients. Case presentation: Our cases were two elderly patients, both of them with past stories of cardiac diseases. Both of them were undergoing amputation indicated for wet gangrene on lower limbs. They had unstable hemodynamics states due to inflammatory state. They were all rated ASA 3. CSA was performed with low doses of local anesthetics and maintenance by reinjections of mixture with the same doses. The interventions took place without major incidents and all patients survived. Conclusion: CSA is an underused technique in modern anesthesia. However, there is renewed interest due to the quality of the blocs and the hemodynamics stability. We report a case series of 2 elderly patients with past stories of cardiac diseases undergoing amputation for dry gangrene that had been operated under CSA.

Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis

AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.

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

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.