93-year-old lady got a new lease of life after successfully operated for acute Cholecystitis

• The patient had Pyocele with gangrene gall bladder and discharged in 48 hrs post-surgery
• After the Covid second wave there is an increase in cases of gangrene with pyocele on youth with 80% more complication ratio

Chennai, 4 August 2021: An expert team of doctors at Fortis Malar Hospital, Adyar performed a complex laparoscopic surgery for a 93-year-old “young (by mind and heart)” lady who was suffering from acute Cholecystitis. It was a Pyocele with gangrene gall bladder. The surgery was successful, and the patient was discharged in 48 hours of hospitalisation. She is now leading a normal life like any other people; and even feels younger and active now.

The patient had undergone treatment for gallstones 3 years before and used stent to remove gallstones. After that she began to develop complication and faced issues due the malfunction of gall bladder. She began to suffer from acute Cholecystitis and the inflammation further worsened, and pus started to fill the gallbladder. The patient deferred meeting the doctor due to the fear of COIVD infection which further deteriorated her health condition. She then brought to the medical experts at Fortis Malar, Adyar for consultation by her family members with the symptoms of severe abdominal pain and vomiting.

She was tested with ultrasound and CT scan to understand the severity of the inflammation. Post diagnosis, report suggested that the patient must undergo for a surgery.Prof. Dr. Neelamekam, Gastroenterologist explained the issue to the patient and told her that surgery is the best option as the inflammation is severe. Not treating the issue immediately will lead to other health complications.

Prof. Dr. Kapali Neelamekam, Sr. Surgeon – Gastro and Minimal Access Surgery, Fortis Malar, Adyar, Chennai, said, “the patient came to me with severe abdominal pain and vomiting. She was diagnosed for acute Cholecystitis and our medical team suggested for a surgery. This lady was hesitant and asked us for options to get the disease treated without surgery; even her family members couldn’t convince her for surgery. After explaining the need for surgery, the lady accepted to go for surgery.

Our medical team consisting of myself, Dr. Mohan Rao and Dr. Naresh performed the surgery with the support of anesthetists Dr. Vidya Mohanram and Dr. Shinu Abdul Rasheed. While dissecting the gallbladder we found pus flowing all around and found it difficult to operate due to frozen calot’s triangle. We couldn’t get the calot right as it is thick and the gangrene of gallbladder sitting dip in the pus. We went down up to the cystic duct and removed it. The patient was discharged within 48 hours after the surgery.”

While comparing the number of cases pre and post COVID he said that “before COVID we used to treat 3-4 patients a month but after the second wave we are witnessing 22-25 patients a month with gall bladder issues, of which 70-80% more complication ratio because of deferring to meet the doctor. The highlight is that we are seeing gangrene with pyocele among youth post COVID. One of the reasons would be deferring meeting the doctor when the issue is small due to the fear of COVID infection or waiting for COVID to go. The waiting period and self-medication will increase the morbidity and complication of surgery. For a simple gall stone which could be operated they are now coming with all the gall stones in the common bile duct which again lead to jaundice due to the delay. He requests the patients meet the doctor as early as possible to not to make the simple things into a complicated issue.”

A multidisciplinary team of medical experts, medical gastroenterologist, infection care team, anesthetists, dieticians, and nurses worked in close coordination and delivered on the clinical excellence regarding the successful surgery.