Complication in Time of COVID-19: Biloma

Abstract

Purpose: After declaration of international health alert for COVID-19 pandemic, the diagnosis of non-viral diseases has decreased. ''Stay at home'' advice and the risk of coronavirus infection makes the patient afraid to approach hospital emergency department. Here is presented a rare complication related to gallbladder perforation with fistula to abdominal wall. A consequence of a subacute cholecystitis which the pacient did not came earlier to hospital because of the risk of virus infection. Methods: A 64-year-old woman developed an asymptomatic abdominal tumour located in the right hypochondrium, measuring 20 centimetres, which had been present for 3 weeks. A CT scan was performed showing an intermuscular cystic tumour in abdominal wall and hepatic subcapsular region. They were identified a perforation of the gallbladder fundus with a fistulous trajectory towards the abdominal wall and a dilatation of the left intrahepatic bile duct, secondary to extrinsic compression. Subsequently, percutaneous drainage of the collection was performed. Followed by scheduled cholecystectomy, which revealed a perforated and inflammated gallbladder and a large cavity with a pyogenic capsule. The anatomical pathology of the specimen was described as chronic cholecystitis. The patient evolved satisfactorily after operation and was discharged on the 2nd postoperative day. Results: After the start of quarantine, there has been a decrease in the number of visits to the emergency department. Acute pathologies such as cholecystitis present at diagnosis with more advanced and severe degrees of evolution compared to those diagnosed before the pandemic. Gallbladder perforation occurs in 12% of acute cholecystitis, with a mortality rate of 16%. In our case, according to Neimeier's classification, it is a subacute perforation type II (frequency 45.9%) with a pericholecystic collection and fistulization towards the abdominal wall, an unusual presentation. Conclusion: The new global epidemiological situation causes fear of infectious-contagious state to prevail over the appearance of new symptoms. This favours a delay in the diagnosis and treatment of acute and chronic pathologies, which then manifest in the patient in more advanced stages and require more complex treatments.