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Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Número 07

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Ginecol Obstet Mex 2023; 91 (07)


Colecistitis aguda asociada con COVID-19 grave en el embarazo. Reporte de caso y revisión de la bibliografía

Barbabosa VJA, Rafaelano MAJ, Guerra AMR, Castillo CJR, Zaldívar ELV

Idioma: Español
Referencias bibliográficas: 62
Paginas: 534-548
Archivo PDF: 1028.35 Kb.


RESUMEN

Antecedentes: Las mujeres embarazadas e infectadas con SARS-CoV-2 tuvieron 2.9 veces más probabilidad de requerir ventilación invasiva. La colecistitis aguda es la segunda indicación quirúrgica más común en el embarazo. En la búsqueda bibliográfica no se encontraron reportes de concomitancia de ambas enfermedades durante el embarazo, por este motivo se publica el reporte de caso clínico y se revisa la bibliografía.
Caso clínico: Paciente de 32 años, en curso de las 23 semanas de embarazo. Debido a síntomas de COVID-19, con prueba PCR positiva, se hospitalizó para inicio de ventilación mecánica invasiva. Al noveno día de internamiento tuvo elevación de transaminasas y reporte de TAC de colecistitis aguda alitiásica. Se le indicó la colecistostomía percutánea, con la que se alivió el cuadro hepatobiliar. En el segundo tiempo quirúrgico se procedió a la cesárea. Tres días después experimentó mejoría ventilatoria y bioquímica gradual. A los 32 días de hospitalización se logró la intubación y, después de 54 días, se dio de alta del hospital, sin requerimiento de oxígeno suplementario.
Conclusiones: Encontrar, en conjunto con el síndrome de insuficiencia respiratoria aguda por COVID-19 grave que requiere ventilación mecánica invasiva, embarazo previable y colecistitis alitiásica pone en grave peligro a la embarazada y al equipo médico en múltiples dilemas médicos, quirúrgicos y bioéticos. La colecistostomía percutánea en pacientes con inestabilidad hemodinámica y la finalización del embarazo en caso de deterioro ventilatorio ante síndrome de insuficiencia respiratoria aguda es una opción controvertida. Lo conducente, sin duda, son los procedimientos basados en evidencia y las sesiones multidisciplinarias, incluyendo a la familia.


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