Five cases of gallbladder gangrene have been recorded in patients who recovered from COVID-19 between June and August 2021 by Delhi’s Sir Ganga Ram Hospitals (SGRH).
Informing about the same, Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreatobiliary Sciences, SGRH, said, “We recently successfully treated five patients of gallbladder gangrene between June and August 2021, who had recovered from COVID-19 infections and presented with severe inflammation of gallbladder without gallstones resulting in gangrene of gallbladder requiring urgent surgery.”
“To the best of our knowledge this is the first report of a series of five cases from India in which the gallbladder gangrene had occurred in patients after recovery from COVID-19 infection,” Prof Arora said.
He further said that these patients were of age group between 37-75 years and four were males while one was female.
All patients had a fever, pain in the right upper quadrant of the abdomen, and vomiting. Two of these patients had diabetes and one also had heart disease.
Three patients received steroids for the management of COVID-19 symptoms. The median duration between COVID-19 symptoms and diagnosis of gallstones was two months.
“Diagnosis in these patients was confirmed using ultrasound and CT scan of the abdomen which showed edema and gangrene in all with concomitant gallbladder perforation in four patients. All these patients successfully underwent laparoscopic removal of necrotic perforated gallbladders,” Prof. Arora informed.
He added that gallstones with the gangrenous gallbladder is a serious condition associated with high morbidity up to 30% to 60% and much higher mortality than gallstones and is usually seen in patients with diabetes, human immunodeficiency virus infection, vascular disease, total parenteral nutrition, prolonged fasting, or being in intensive care unit and those with underlying history of trauma, burns, and sepsis.
“Surprisingly all our patients had recovered from COVID and did not have the common and conventional predisposing factors (mentioned above),” Prof Arora said.
He pointed out that it is postulated that gallbladder epithelial cells are very similar to bile duct cells, as they richly express receptors and could be a target for SARS-CoV-2 or the body’s dysregulated immunological response against the virus.
“This result in severe inflammation of gallbladder wall as well as the endothelial lining of the blood vessels resulting in subclinical coagulopathy and compromised blood supply of the cystic artery supplying the gallbladder thus resulting in mucosal edema ischemia and gangrene of gallbladder culminating in perforation in four of five cases in our series,” Prof Arora explained.