Laparoscopic cholecystectomy for the treatment of acute cholecystitis in a Vietnamese male patient with ankylosing spondylitis combined with chronic obstructive pulmonary disease: A rare case report.
Int J Surg Case Rep 2021;
90:106646. [PMID:
34896777 PMCID:
PMC8666572 DOI:
10.1016/j.ijscr.2021.106646]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION
Ankylosing spondylitis (AS) presents with difficulty in intubation, restricted ventilatory abnormalities, and frequent cardiac involvement. However, with improvements in anaesthesiology and surgical expertise, laparoscopic cholecystectomy can be extended to individuals with kyphoscoliosis caused by AS.
CASE PRESENTATION
We report the case of a 68-year-old man who had severe AS for more than 30 years following necrosis acute cholecystitis. Signs of severe AS included the patient's inability to lie down and difficulty in breathing. We utilised four trocars but changed the placement positions and used suction tubes during laparoscopic cholecystectomy. The patient was discharged from the hospital after 14 days.
DISCUSSION
Severe AS is not a contraindication to laparoscopic surgery. However, patients with AS or kyphosis must be carefully assessed for respiratory dysfunction, cardiac impairment, difficult airway, and other special conditions. Anaesthesiologists and surgeons should collaborate with surgical decisions in patients with severe respiratory limitations.
CONCLUSION
Laparoscopic cholecystectomy can be performed effectively in patients with severe AS. With the use of a laparoscopic hook and suction equipment, it is possible to easily dissect the Calot triangle during acute cholecystitis.
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