Gallbladder gangrene reported in 5 patients who recovered from Covid; ‘first such case in India’, say doctors
Doctors at Sir Ganga Ram Hospital have seen five patients who developed gallbladder gangrene after recovering from Covid-19. Medical experts at the hospital believe this is the first report of such cases in India.
The five patients – four men and a woman aged between 37 and 75 – were successfully treated at the hospital between June and August. They 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 management of Covid-19 symptoms.
Dr Anil Arora, Chairman of the Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences at the hospital, said, “We recently successfully treated five patients for gallbladder gangrene between June to August 2021, who had recovered from Covid-19 infection and presented with severe inflammation of gallbladder without gallstones (acalculous cholecystitis) 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 gallbladder gangrene had occurred in patients after recovery from Covid-19 infection.”
The median duration between Covid-19 symptoms and diagnosis of “acalculous cholecystitis” was two months, and diagnosis was confirmed through ultrasound and CT scan of the abdomen.
Gallbladder stone disease is a very common problem in North India (affecting 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 gallbladder without evidence of gallstones or cystic duct obstruction.
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 30-60%) and much higher mortality than “calculous cholecystitis”.
It is usually seen in patients suffering from diabetes, HIV, vascular disease, total parenteral nutrition, those on prolonged fasting, in ICUs, and those with underlying history of trauma, burns and sepsis.
According to doctors, all five patients had recovered from Covid-19 and did not have the common and conventional predisposing factors mentioned above.
Dr Praveen Sharma, Senior Consultant, Gastroenterology Department, said: “Timely diagnosis and early intervention with broad spectrum antibiotics may prevent the development of onerous complication of gangrene and perforation of gallbladder.”