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Gall bladders of five Covid recovered patients removed due to severe inflammation

New Delhi: Five Covid-19 recovered patients suffered severe inflammation in the gall bladder which had to be removed surgically, a private hospital in Delhi reported on Thursday. 
“We recently successfully treated five patients of gall bladder gangrene between June to August this year who had recovered from Covid-19 infection and presented with severe inflammation of gall bladder without gall stones resulting in gangrene of gall bladder requiring urgent surgery. To the best of our knowledge this is the first report of series of five cases from India in which the gall bladder gangrene had occurred in patients after recovery from Covid-19 infection,” said Dr Anil Arora, Chairman, Institute of Liver, Gastroenterology and Pancreatobiiliry Sciences, Sir Ganga Ram Hospital.
According to medical literature, such condition where inflammation of the gall bladder is reported without the presence of stones is called Acalculous Cholecystitis, it’s prevalence is 10 per cent in gall bladder stone disease, doctors said.
“Gall bladder stone disease is a very common problem in North India (8 pc of the general population) and is responsible for 90 pc cases of acute inflammation called cholecystitis. Only 10 pc of patients have non-calculous inflammation of gall bladder called acalculous cholecystitis,” Dr Arora added.
The hospital said that the patients, four male and a female, aged between 37-75 years experienced symptoms such as 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 Acalculous Cholecystitis was two months. Diagnosis in these patients was confirmed using ultrasound and CT scan of the abdomen,” Arora said.
The hospital said that after the second wave, the condition was noticed in many patients, especially those who had recovered from the Covid-19.
“It is postulated that 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 gall bladder wall,” the doctor said.
“Acalculous cholecystitis with gangrenous gall balder is a serious condition associated with high morbidity up to 30 to 60 pc and much higher mortality than Calculous Cholecystitis and is usually seen in patients with diabetes, human immunodeficiency virus (HIV) infection, vascular disease, total parenteral nutrition, prolonged fasting, or being in an intensive care unit (ICU) and those with underlying history of trauma, burns and sepsis,” he added.
Dr Praveen Sharma, Senior Consultant, Gastroenterology Department, Gangaram Hospital, said that patients with a history of Covid-19 are more likely to develop inflammation in Gall bladder.
“A timely diagnosis and early intervention with broad-spectrum antibiotics may prevent the development of onerous complication of gangrene and perforation of the gall bladder,” he added.

(EW Correspondent)



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