India / 5 get gallbladder gangrene after COVID recovery, doctors say '1st such case in India'

New Delhi: Doctors from Sir Ganga Ram hospital have reported cases of people who have recovered from Covid-19 returning with gall bladder gangrene (tissue death due to loss of blood supply). The doctors have treated five such patients over the past two months, with four of them reaching the hospital with a hole in their gall bladder.

The patients needed urgent surgery to remove the gall bladder and have recovered.

Inflammation of the gall bladder, which led to gangrene in the current cases, usually happens in those with gall stones. An acute inflammation without stones is usually seen only in 10% cases where the patient is either has a weakened immune system or has suffered an injury.

“Gall bladder inflammation without stone is usually seen in patients with HIV, those who have received nutrition through IV, prolonged fasting, those who have been in the intensive care unit for long, and those who have had an accident or burns. The patients did not have these factors; they developed the acute inflammation nearly two months after recovering from Covid-19 and not during their hospital stay,” said Dr Anil Arora, chairman, Institute of Liver, Gastroenterology, Pancreaticobiliary Science at the hospital.

He also said that mortality is high – 30 to 60% – in patients who develop gall bladder inflammation in the absence of stones because of the conditions that led to the inflammation in the first place. “Surgery in people with compromised immune system or with burns increases the risk of mortality. But, we did not see that in Covid-19 patients. All of them recovered and are doing well,” he said.

Doctors suggest that those looking at patients with a history of Covid-19 with pain in the right upper abdomen should suspect gall bladder inflammation and start treatment early to prevent gangrene and perforations. Dr Praveen Sharma, senior consultant of gastroenterology, said, “There should be a high degree of suspicion of this in patients with pain in the right upper quadrant and a history of Covid-19.”

Dr Shashi Dhawan, senior consultant pathologist at the hospital, found severe inflammation and injury due to lack of blood supply along with damage to the vessels in the patient samples. This led the doctors to believe that Covid-19 might be causing the gall bladder inflammation with the stones.

“The Sars-CoV-2 virus enters through the respiratory system and affects the lungs the most as it has high number of ACE-2 receptors that the virus uses to bind to human cells. After lungs, the gastrointestinal tract and the biliary system (bile duct, gall bladder and associated structures) have the highest ACE-2 receptors. We think the virus might be attaching to the gall bladder lining and dysregulating the immune system causing injury to the gall bladder,” said Dr Arora.

He added, “The virus might also be causing tiny clots due that are not detected due to damage to the blood vessels. This is a known mechanism of Sars-CoV-2 which is why we are hearing of cases of stroke and heart attacks after Covid-19.”