Five patients developed gallbladder gangrene after recovering from COVID-19, with doctors at the Sir Ganga Ram Hospital in New Delhi saying that it is the first report of such cases in India.
The five patients were successfully treated at the hospital between June and August.
Dr. Anil Arora, Chairman of the Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences at the hospital, said, “We successfully treated five such patients between June and August. After recovering from COVID-19, these patients presented with severe inflammation of gallbladder without gallstones resulting in gangrene of gallbladder requiring urgent surgery.” He claimed it is the first time that cases of gallbladder gangrene have been reported after recovery from COVID-19 infection.
Gall bladder stone disease is a very common problem in North India (reported in 8% of the general population) and is responsible for 90% cases of acute inflammation called cholecystitis. Only 10% of patients have ‘acalculous cholecystitis’ which is inflammation of the gallbladder without evidence of gallstones or cystic duct obstruction.
These five patients – four men and a woman – were aged between 37 and 75. All patients complained of fever, pain in the right upper quadrant of abdomen and vomiting. Two of them had diabetes and one suffered from heart disease. Three patients had received steroids for the management of COVID-19 symptoms.
The median duration between COVID-19 symptoms and diagnosis of ‘acalculous cholecystitis’ was two months. Diagnosis was confirmed through ultrasound and CT scan of abdomen.
All these patients successfully underwent laparoscopic removal of necrotic perforated gall bladders, Dr. Arora said.
He added that ‘acalculous cholecystitis’ with gangrenous gallbladder is a serious condition associated with high morbidity (up to 30 to 60%) and much higher mortality than ‘calculous cholecystitis’.
It is usually seen in patients suffering from diabetes, HIV infection, vascular disease, total parenteral nutrition, those on prolonged fasting, in intensive care units and those with underlying history of trauma, burns and sepsis.
Surprisingly, all the patients had recovered from COVID-19 and did not have the common and conventional predisposing factors mentioned above.
“Gallbladder epithelial cells are very similar to bile duct cells, as they richly express receptors (ACE2), and could be a target for SARS-CoV-2 or body’s dysregulated immunological response against the virus resulting in severe inflammation of gallbladder,” Dr. Arora said.
A few case reports of similar illness have been described in literature in its association with COVID-19 infection, he added.
According to Dr. Praveen Sharma, Senior Consultant, Gastroenterology Department, “A timely diagnosis and early intervention with broad spectrum antibiotics may prevent the development of onerous complication of gangrene and perforation of gallbladder.”
