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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Salukhov VV, Lopatin YR, Minakov AA, Bogomolov АB, Salosina EO. [Acute non-calculous cholecystitis in a young aged patient with COVID-19: A case report]. TERAPEVT ARKH 2023; 95:692-695. [PMID: 38158907 DOI: 10.26442/00403660.2023.08.202317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Indexed: 01/03/2024]
Abstract
To date, it is known that COVID-19 can lead to damage to various organs and systems, despite the statistical prevalence of respiratory manifestations of the disease. In some cases, in order to treat complications of coronavirus infection, a multidisciplinary approach may be required, including on an urgent basis. The article presents a clinical case of acute non-calculous cholecystitis in a 41-year-old patient with COVID-19. The importance of timely diagnosis and providing the possibility of emergency surgical care to patients with COVID-19, even under the conditions of the anti-epidemic regime, has been demonstrated.
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Bakshi N, Yar Khan N, Grewal N, Muhanna A, Slim J. A Rare Case of COVID-19 Presenting as Acalculous Cholecystitis. Cureus 2023; 15:e46332. [PMID: 37920616 PMCID: PMC10618052 DOI: 10.7759/cureus.46332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
At its onset, coronavirus disease 2019 (COVID-19) commonly presents with generalized myalgia and upper respiratory symptoms. COVID-19 presenting as acalculous cholecystitis has been rarely described in the literature. The following case presents a patient whose first presentation of COVID-19 was acalculous cholecystitis without respiratory symptoms, critical illness, or severe COVID-19 infection.
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Affiliation(s)
- Nayaab Bakshi
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Nibras Yar Khan
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Navjot Grewal
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Alaa Muhanna
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
| | - Jihad Slim
- Infectious Diseases, Saint Michael's Medical Center, Newark, USA
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Kwei-Nsoro R, Attar B, Shaka H, Ojemolon P, Sana M, Shaka AT, Baskaran N, Kanemo P, Doraiswamy M. Independent Predictors and Causes of Thirty-Day Gastrointestinal Readmissions Following COVID-19-Related Hospitalizations: Analysis of the National Readmission Database. Gastroenterology Res 2023; 16:157-164. [PMID: 37351083 PMCID: PMC10284648 DOI: 10.14740/gr1623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/02/2023] [Indexed: 06/24/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic led to significant mortality and morbidity in the United States. The burden of COVID-19 was not limited to the respiratory tract alone but had significant extrapulmonary manifestations. We decided to examine the causes, predictors, and outcomes of gastrointestinal (GI)-related causes of 30-day readmission following index COVID-19 hospitalization. Methods We used the National Readmission Database (NRD) from 2020 to identify hospitalizations among adults with principal diagnosis of COVID-19. We identified GI-related hospitalizations within 30 days of index admission after excluding elective and traumatic admissions. We identified the top causes of GI-related readmission, and the outcomes of these hospitalizations. We used a multivariate Cox regression analysis to identify the independent predictors of readmission. Results Among 1,024,492 index hospitalizations with a primary diagnosis of COVID-19 in the 2020 NRD database, 644,903 were included in the 30-day readmission study. Of these 3,276 (0.5%) were readmitted in 30 days due to primary GI causes. The top five causes of readmissions we identified in this study were GI bleeding, intestinal obstruction, acute diverticulitis, acute pancreatitis, and acute cholecystitis. Multivariate Cox regression analysis done adjusting for confounders showed that renal failure, alcohol abuse, and peptic ulcer disease were associated with increased odds of 30-day readmission from GI-related causes. Conclusions GI manifestations of COVID-19 are not uncommon and remain an important cause of readmission. Targeted interventions addressing the modifiable predictors of readmission identified will be beneficial in reducing the burden on already limited healthcare resources.
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Affiliation(s)
- Robert Kwei-Nsoro
- Department of Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Bashar Attar
- Division of Gastroenterology and Hepatology, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Hafeez Shaka
- Division of Hospital Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Pius Ojemolon
- Department of Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Muhammad Sana
- Department of Internal Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Abdul Tawab Shaka
- Department of Medicine, Windsor University School of Medicine, St Kitts, West Indies
| | - Naveen Baskaran
- Division of Hospital Medicine, University of Florida, Gainesville, FL, USA
| | - Philip Kanemo
- Division of Hospital Medicine, Rapides Regional Medical Center, Alexandria, LA, USA
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Awan JR, Akhtar Z, Inayat F, Farooq A, Goraya MHN, Ishtiaq R, Malik S, Younus F, Kazmi S, Ashraf MJ, Khan AA, Tarar ZI. Acute acalculous cholecystitis as a rare gastroenterological association of COVID-19: a case series and systematic review. J Clin Transl Res 2023; 9:133-143. [PMID: 37179790 PMCID: PMC10171317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/19/2023] [Accepted: 03/07/2023] [Indexed: 05/15/2023] Open
Abstract
Background and Aim Acute acalculous cholecystitis (AAC) is an acute inflammatory disease of the gallbladder in the absence of cholecystolithiasis. It is a serious clinicopathologic entity, with a high mortality rate of 30-50%. A number of etiologies have been identified that can potentially trigger AAC. However, clinical evidence on its occurrence following COVID-19 remains scarce. We aim to evaluate the association between COVID-19 and AAC. Methods We report our clinical experience based on 3 patients who were diagnosed with AAC secondary to COVID-19. A systematic review of the MEDLINE, Google Scholar, Scopus, and Embase databases was conducted for English-only studies. The latest search date was December 20, 2022. Specific search terms were used regarding AAC and COVID-19, with all associated permutations. Articles that fulfilled the inclusion criteria were screened, and 23 studies were selected for a quantitative analysis. Results A total of 31 case reports (level of clinical evidence: IV) of AAC related to COVID-19 were included. The mean age of patients was 64.7 ± 14.8 years, with a male-to-female ratio of 2.1:1. Major clinical presentations included fever 18 (58.0%), abdominal pain 16 (51.6%), and cough 6 (19.3%). Hypertension 17 (54.8%), diabetes mellitus 5 (16.1%), and cardiac disease 5 (16.1%) were among the common comorbid conditions. COVID-19 pneumonia was encountered before, after, or concurrently with AAC in 17 (54.8%), 10 (32.2%), and 4 (12.9%) patients, respectively. Coagulopathy was noted in 9 (29.0%) patients. Imaging studies for AAC included computed tomography scan and ultrasonography in 21 (67.7%) and 8 (25.8%) cases, respectively. Based on the Tokyo Guidelines 2018 criteria for severity, 22 (70.9%) had grade II and 9 (29.0%) patients had grade I cholecystitis. Treatment included surgical intervention in 17 (54.8%), conservative management alone in 8 (25.8%), and percutaneous transhepatic gallbladder drainage in 6 (19.3%) patients. Clinical recovery was achieved in 29 (93.5%) patients. Gallbladder perforation was encountered as a sequela in 4 (12.9%) patients. The mortality rate in patients with AAC following COVID-19 was 6.5%. Conclusions We report AAC as an uncommon but important gastroenterological complication following COVID-19. Clinicians should remain vigilant for COVID-19 as a possible trigger of AAC. Early diagnosis and appropriate treatment can potentially save patients from morbidity and mortality. Relevance for Patients AAC can occur in association with COVID-19. If left undiagnosed, it may adversely impact the clinical course and outcomes of patients. Therefore, it should be considered among the differential diagnoses of the right upper abdominal pain in these patients. Gangrenous cholecystitis can often be encountered in this setting, necessitating an aggressive treatment approach. Our results point out the clinical importance of raising awareness about this biliary complication of COVID-19, which will aid in early diagnosis and appropriate clinical management.
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Affiliation(s)
| | - Zahra Akhtar
- University of Texas Medical Branch, Galveston, TX, USA
| | - Faisal Inayat
- Allama Iqbal Medical College, Lahore, Pakistan
- Corresponding author: Faisal Inayat Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore 54550, Punjab, Pakistan. Tel: +92 321 774 3758 Fax: +92 42 9923 1443
| | | | | | - Rizwan Ishtiaq
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Sana Malik
- University Maternity Hospital Limerick, Limerick, Ireland
| | | | - Sana Kazmi
- Dow University of Health Sciences, Karachi, Pakistan
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Alqatari S, Alkhafaji DM, AlShammari LT, AlArgan R, Alwaheed A, Boumarah DN. COVID-19 and Malignancy: What is the Association? A Case Report and Review of the Literature. Med Arch 2023; 77:237-240. [PMID: 37700926 PMCID: PMC10495138 DOI: 10.5455/medarh.2023.77.237-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/24/2023] [Indexed: 09/14/2023] Open
Abstract
Background After more than two years since Coronavirus disease 2019 (COVID-19) was first identified as a global pandemic, we still observe a variety of clinical presentations. From asymptomatic carriers to severely ill patients. Most patients infected with COVID-19 present with respiratory symptoms. Objective However, case reports of different presentations were published, none of them highlighted the potential of COVID-19 to facilitate the manifestation of hidden malignancy, particularly, gallbladder carcinoma. Case presentation In this report, we present a case of a 77-year-old Saudi lady with multiple comorbidities, presented with an acute confusional state after one month of having asymptomatic COVID-19 infection. Significantly, she was completely functional prior to her presentation and did not manifest any symptoms such as weight loss or fever. Her clinical assessment demonstrated severe abdominal tenderness and guarding on palpation. Computed tomography scans of the abdomen showed perforated gallbladder cancer. Conclusion Among multiple clinical presentations related to COVID-19 infection, gastrointestinal manifestations are the most common extrapulmonary symptoms, ranging from mild to more severe symptoms. Acute abdomen with perforated viscus should be kept in mind as a differential diagnosis when dealing with COVID-19 infected patients who present with severe abdominal pain. The current case report highlights one of unusual presentations of COVID-19 infection.
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Affiliation(s)
- Safi Alqatari
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Dania M. Alkhafaji
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Lateefah T. AlShammari
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Reem AlArgan
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abrar Alwaheed
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Dhuha N. Boumarah
- Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
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Wu D, Hacking S, Lee L. A Series of COVID-19 Cases With Findings in the Gastrointestinal and Hepatobiliary System. Cureus 2022; 14:e22602. [PMID: 35355548 PMCID: PMC8957856 DOI: 10.7759/cureus.22602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide. Most of the infected patients present with respiratory symptoms and acute lung damage. Here, we present three cases of patients with COVID-19 disease whose main clinical manifestations are gastrointestinal symptoms. In our first case, we present a COVID-19 patient with histologic findings associated with ischemic necrosis of the small bowel. In the second and third cases, we demonstrate acute cholecystitis and histology showing microvascular thrombosis. These three cases highlight the ischemic and thrombotic changes seen in the setting of COVID-19 infection without classic respiratory symptoms, with resulting severe gastrointestinal and hepatobiliary disease requiring surgical management. Although the bile or stool viral load was not tested in these patients, the small intestine and gallbladder were infected with SARS-CoV-2, most likely via the epithelial angiotensin-converting enzyme 2 (ACE2) receptor.
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Bozada-Gutiérrez K, Trejo-Avila M, Chávez-Hernández F, Parraguirre-Martínez S, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature. World J Clin Cases 2022; 10:1296-1310. [PMID: 35211563 PMCID: PMC8855198 DOI: 10.12998/wjcc.v10.i4.1296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/16/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Research concerning postoperative outcomes of confirmed coronavirus disease 2019 (COVID-19) patients revealed unfavorable postoperative results with increased morbidity, pulmonary complications and mortality. Case reports have suggested that COVID-19 is associated with more aggressive presentation of acute cholecystitis. The aim of the present study is to describe the perioperative assessment and postoperative outcomes of ten patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with concomitant acute cholecystitis who underwent cholecystectomy.
CASE SUMMARY We report a total of 10 SARS-CoV-2 positive patients with concomitant acute cholecystitis that underwent cholecystectomy. Six patients were males, the mean age was 47.1 years. Nine patients had moderate acute cholecystitis, and one patient had severe acute cholecystitis. All patients were treated with urgent/early laparoscopic cholecystectomy. Regarding the Parkland grading scale, two patients received a Parkland grade of 3, two patients received a Parkland grade of 4, and six patients received a Parkland grade of 5. Eight patients required a bail-out procedure. Four patients developed biliary leakage and required endoscopic retrograde cholangiopancreatography with biliary sphincterotomy. After surgery, five patients developed acute respiratory distress syndrome (ARDS) and required intensive care unit (ICU) admission. One patient died after cholecystectomy due to ARDS complications. The mean total length of stay (LOS) was 18.2 d. The histopathology demonstrated transmural necrosis (n = 5), vessel obliteration with ischemia (n = 3), perforation (n = 3), and acute peritonitis (n = 10).
CONCLUSION COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.
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Affiliation(s)
- Katya Bozada-Gutiérrez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Mario Trejo-Avila
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Fátima Chávez-Hernández
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | | | - Carlos Valenzuela-Salazar
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Jesús Herrera-Esquivel
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
| | - Mucio Moreno-Portillo
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City 14090, Mexico
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Insuficienţă hepatică acută asociată cu infecţie recentă cu SARS-CoV-2 la un copil – prezentare de caz. PEDIATRU.RO 2022. [DOI: 10.26416/pedi.65.1.2022.6336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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