Acute Acalculous Cholecystitis in a Patient with Covid - 19

Acute alithiasic cholecystitis (AAC), also called acalculous, corresponds to the presence of an inflammation of the gallbladder in the absence of stones inside, it is a rare entity (10%), reported in diabetic patients, immunosuppressed, with pathologies infectious (viral, bacterial), major surgery, drugs, multiple trauma, mechanical ventilation, use of vasopressors, opioid analgesics, prolonged fasting, total parenteral nutrition, burns, among others. In this time of the SARS CoV-2 virus / COVID-19 coronavirus disease pandemic, surgeons have found an increase in the request for interconsultations from respiratory hospitalization services, intermediate care and intensive care units, due to ultrasound findings of incidental abdomen of acute alithiasic cholecystitis in those patients without improvement to treatment or worsening of sepsis, or the cytokine cascade, difficult to evaluate abdominal epigastric pain, right upper quadrant, induces us to explore and find little painful palpable gallbladder, reporting edema gallbladder wall greater than 3 mm, gallbladder distention, sometimes ultrasound Murphy’s sign, extending imaging studies according to the patient’s conditions with contrasted computed axial tomography and nuclear magnetic cholangioresonance, and even with reports of micro perforations with peri-vesicular extravasation of contents , free air on its walls, ruling out other causes of acalculous cholecystitis. It is a real diagnostic and therapeutic challenge in these patients with the SARS virus –COV-2 / COVID-19, already afflicted by viremia, or in some cases subjected to cytokine storms, poor general conditions, hermodynamically unstable in Intensive care units, intubated, with vasopressor support, and even some overcoming the emergency, what would be the best time to resolve Acute acalculous cholecystitis medically or surgically? This is the big question.