Is gallbladder gangrene a new post-Covid risk?

New Delhi, Sep 17 (IANS): Doctors at Sir Ganga Ram hospital (SGRH) here on Friday reported five cases of gallbladder gangrene among people two months after they recovered from Covid-19 infections.

The gallbladder is a small, pear-shaped organ on the right side of the abdomen, beneath the liver. Its function is to store bile needed for the digestion of fats in food. If the bile builds up within the gallbladder, causing cholecystitis, the bile may become infected. Untreated cholecystitis can then cause tissue in the gallbladder to die -- gangrene.

In usual cases, stones in the organ lead to inflammation, or cholecystitis. But, in the absence of the gallstones, the inflammation of the gallbladder is called calculus cholecystitis and it occurs in people admitted for long in the Intensive Care Unit, or those with severe sepsis or diabetes.

However, the patients in this case, had no ICU stay, Dr Anil Arora, Chairman, Institute of Liver, Gastroenterology, Pancreaticobiliary Science at the hospital, told IANS.

They had mild-to-moderate Covid, which required hospitalisation and once they recovered they went home and were fine. After two months, they returned to the hospital with abdominal pain, and vomiting.

"These patients had recovered from Covid-19 infection. But the inflammation was so severe, it led to the gangrene of the gallbladder and four out of the five patients had ruptured gallbladder. And they all needed surgery, and luckily everybody recovered," he said.

So can this condition be called a long Covid symptom? No, in long Covid, one continues to have some symptoms, after recovery. But here, these patients were perfectly normal, after recovering from Covid, Arora said.

According to Arora, the condition is caused by the ACE2 receptor -- the key for Covid infection. ACE2 receptor is found in lungs, through which SARS-CoV-2, the virus causing Covid-19, enters into the body cells. Similarly, the bile duct and the epithelium, as well as the gallbladder also have the same receptor.

"A high concentration of ACE2 receptors is conducive to the entry of the virus. When the virus enters into cells, it causes dysregulated immune response. We think this is caused by dysregulated abnormal and weird immune responses due to the Covid antigen which had produced this," he noted.

"Its a weird virus one that doesn't know about. Antigen and antibodies produced by the Covid virus can be the reason. Maybe it affects other organs, this cannot be documented without further testing the tissues for Covid," he added.

Among those without Covid, the risk of the condition is due to being long in ICU with prolonged fasting. Because of the fasting state, the gallbladder bile becomes thick, which can cause acute acalculous cholecystitis. Patients with severe sepsis and patients with burns and trauma are also at risk of their condition, Arora said.

"In case you have pain in the region of the gallbladder -- on the right upper part of the body on the right side below the rib cage -- then think of inflammation. It can be treated if detected early," Arora suggested. "In fact, 30 to 60 per cent of the patients with cholecystitis and gangrene will die. They will die not because of the gangrene, but they'll die because they are very sick already and this is an added complication. The death risk is much more in patients who have no gallstones, than those who have gallstones."

"When at least for three to six months after recovering from Covid, if you continue to have problems see your doctor immediately, let him look at additional findings in the body which may be related to Covid. Do not ignore the symptoms," Arora advised.



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