Philippine Journal of Surgical Specialties Vol. 75, No. 1, January-June 2020, pp 49-52
PAHPBS Management Guidelines on Acute Cholecystitis and Gallbladder Disease During the COVID-19 Pandemic
Author(s): Philippine Association of Hepato-Pancreatico-Biliary Surgeons
Abstract:
Guiding Principles and Summary of Goals of Management
- Provide the best possible and timely surgical care for all patients with Gallbladder Disease
- Limit exposure of all patients and healthcare workers to the coronavirus
- Properly allot and preserve resources to the care for coronavirus patients
General Considerations
Symptomatic Cholelithiasis
- Pain management for patients with symptomatic cholelithiasis and chronic cholecystitis
- Surgery should be delayed and performed electively
- For patients with progressive symptoms and with pain refractory to medical management, consider laparoscopic cholecystectomy.
Choledocholithiasis
- Choledocholithiasis without signs of cholangitis may be observed and managed expectantly
- For those with larger stones and those who fail to spontaneously pass their stone, an ERCP with sphincterotomy may be done, followed by elective cholecystectomy.
- Note that appropriate precautions should be taken for ERCP in patients with COVID-19 infection as it should be considered an aerosolizing procedure.
Cholangitis
- Patients with ascending cholangitis often respond to broad spectrum antibiotics and appropriate resuscitation.
- For patients that fail to clinically improve and those with sepsis, ERCP and sphincterotomy are indicated.
- For concomitant cholecystitis, percutaneous cholecystostomy may be appropriate.
- Note that appropriate precautions should be taken for ERCP in patients with COVID-19 infection as it should be considered an aerosolizing procedure.
- Cholecystectomy should be performed in a delayed fashion.
Acute Cholecystitis
- Healthy and low risk patients with acute cholecystitis should undergo laparoscopic cholecystectomy to minimize hospital stay. Table 1 shows that Cholecystitis is considered an urgent case and decision on surgical management should be done in < 24 hours.
- For elderly and high-risk patients, or an operating room is not available, or resources are scarce, consider IV antibiotics.
- Patients who fail to clinically improve on antibiotics, and those with signs of sepsis should undergo percutaneous cholecystostomy in addition to the administration of IV antibiotics.
Key words: Acute Cholecystitis and Gallbladder Disease