After Covid-19 recovery, 5 patients treated for gallbladder gangrene in first such case in India
Five patients developed gallbladder gangrene after recovering from coronavirus disease (Covid-19) and were surgically treated at Delhi’s Sir Ganga Ram Hospital, which said they were the first such cases in India. Dr Anil Arora, the chairperson at the Institute of Liver, Gastroenterology and Pancreatobiiliry Sciences, said they have successfully treated the five patients with gall bladder gangrene between June and August this year.
"They reported severe inflammation of gall bladder without gall stones (acalculous cholecystitis) resulting in gangrene of gall bladder requiring urgent surgery. To the best of our knowledge, this is the first time five cases have been reported from India in which the gall bladder gangrene had occurred in patients after recovery from COVID-19,” Dr Arora said.
The five patients, including four men and a woman, were aged between 37 and 75 and all of them complained of fever, pain in the right upper quadrant of the abdomen and vomiting. While two of them have diabetes and one has heart disease and three received steroids for the management of Covid-19 symptoms.
According to Dr Arora, the median duration between Covid-19 symptoms and diagnosis of acalculous cholecystitis was two months, which was confirmed through ultrasound and CT scan of the abdomen. “All these patients successfully underwent laparoscopic removal of necrotic perforated gallbladders," Dr Arora said.
He added that acalculous cholecystitis with the gangrenous gallbladder is a serious condition associated with high morbidity—up to 30 to 60 per cent—and much higher mortality than "calculous cholecystitis".
It is usually seen in patients suffering 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.
“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 the gallbladder,” the senior doctor said.
A few case reports of similar illness have been described in the literature in its association with Covid-19 infection, he added.
Dr Praveen Sharma, a senior consultant at the gastroenterology department of Sir Ganga Ram Hospital, said that timely diagnosis is the key to the prevention of the condition. "In this smouldering pandemic, a high index of suspicion of this entity in a patient with fever and right upper quadrant pain especially with a history of recent recovery from Covid-19 infection besides timely diagnosis and early intervention with broad-spectrum antibiotics may prevent the development of onerous complication of gangrene and perforation of the gall bladder," Dr Sharma was quoted as saying by news agency ANI.
Gall bladder stone disease is very common in north India (eight per cent of the general population) and is responsible for 90 per cent of cases of acute inflammation called cholecystitis. Only 10 per cent of the patients have acalculous cholecystitis.
(With agency inputs)