Case Report
Volume 8 Issue 5 - 2021
Necrotized Acalculous Cholecystitis Associated with SARS-CoV2 (COVID-19)
José Alberto Martinez Valdes*, Irving Arroyo Benitez, Oscar Fernando Arciniega Maldonado, Héctor Armando Miranda Blasnich, Paul Ernesto Charis Trujillo, José Carlos Miranda Cruz, Leslie Azarel Callejas Reyes, Manuel Cornish Estrada and Alfredo Leonardo Ortiz Nieto
General Surgeon, General Surgery Department at “Ticomán General Hospital” General Hospital of Mexico City’s Ministry of Health, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
*Corresponding Author: José Alberto Martinez Valdes, General Surgeon, General Surgery Department at “Ticomán General Hospital” General Hospital of Mexico City’s Ministry of Health, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
Received: April 08, 2021; Published: April 26, 2021




Abstract

Introduction: The coronavirus disease (COVID-19), caused by the Severe Acute Respiratory Syndrome (SARS-Cov-2), has rapidly become a global pandemic, mainly affecting the respiratory system. However, it has been demonstrated that it also affects other systems such as the digestive, renal, hepatic, integumentary, and circulatory systems, having endothelial injury as a common denominator. Injuries to the digestive system have had a significant impact on the surgical area, as surgeons have had to quickly react to this unprecedented clinical challenge by systematically reusing operating rooms.

Treatment for COVID-19 is symptomatic and oxygen therapy represents the main treatment intervention for patients with severe infections. However, in patients with acute abdomen, treatment has not changed, open or laparoscopic surgery remain as the gold standards, in addition to the specific treatment for COVID-19.

Objective: Presentation before the surgical community of a clinical case from the Ticomán General Hospital of Mexico City’s Ministry of Health about the presence and association of acalculous cholecystitis associated with COVID-19.

Results: Clinical case of a 77-year-old female patient who was admitted to the emergency room due to colicky abdominal pain located in the right hypochondrium and epigastrium, presenting nausea and multiple vomiting episodes of bile, showing data of a systemic inflammatory response, as well as acute abdomen. She was examined by our general surgery department and with an Exploratory Laparotomy the surgical management was decided, which resulted in the following findings: Necrotized acalculous gallbladder in its entirety, multiple adhesions Zühlke IV loop/wall, loop/gallbladder, gallbladder/loop, perivesical fluid of cloudy appearance approximately 300cc. Hepatocystic triangle with distortion of the anatomy, performing a Partial Reconstituting Cholecystectomy. Surgical specimen is sent to pathology where micro cuts are made with hematoxylin and eosin staining and Masson's Trichome staining observing micro thrombosis; she has a torpid evolution during the postoperative period, and presents desaturation up to 80% in the environment, a test is taken for COVID-19, which is positive, triggering a metabolic response and significant respiratory failure of the patient, which results in her death.

Discussion: COVID-19 has been shown to replicate primarily in airway epithelial cells via input receptors for angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 can cause liver injury similar to respiratory coronaviruses, since they share the same genome, although their incidence is lower than that of SARS-CoV infection; 5%-37% versus 60-70%, respectively. Histological and immunohistochemical studies in cutaneous, pulmonary, and intestinal pathology involve microvascular injury and thrombosis, which consists in the activation of the alternate pathway and the complement lectin pathway.

Acute acalculous cholecystitis (AAC) is the inflammation of the gallbladder without evidence of calculi inside; uncommon amongst the spectrum of biliary disease. Most patients with acalculous cholecystitis have multiple risk factors such as trauma, cardiopulmonary resuscitation, mechanical ventilation, sepsis, burns, human immunodeficiency virus (HIV), immunodeficiency states, long-term total parenteral nutrition, and major surgery.

The entry of the SARS-CoV-2 virus is mediated by expressed ACE 2 receptors in the liver, gallbladder, and vascular endothelium; therefore, it is possible that COVID-19 causes endotheliitis in the gallbladder, thus leading to inflammation and necrosis. Laparoscopic cholecystectomy remains the treatment of choice for acute cholecystitis even in the COVID-19 era.

Conclusion: COVID-19 infection leads to systemic inflammation and endothelial damage to various organs, with acalculous cholecystitis being one of the variants of this disease, which may potentially complicate the clinical status of these patients. Currently, there is no clear consensus to treat acalculous cholecystitis secondary to COVID-19, but it depends mainly on the clinical status of the patient and the severity of the disease.

In conclusion, acalculous cholecystitis secondary to COVID-19 infection can have fatal complications such as necrosis and perforation of the gallbladder; Laparoscopic surgery is no more likely to spread COVID-19 infection than open surgery.

Keywords: Cholecystitis; Acalculous; COVID-19; SARS CoV2; Acute Abdomen; Necrosis

References

  1. CL Yang., et al. “Coronavirus disease 2019: a clinical review”. European Review for Medical and Pharmacological Sciences 24 (2020): 4585-4596.
  2. Cascella M., et al. “Features, Evaluation and Treatment Coronavirus (COVID-19)”. Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020- (2020).
  3. Chan JF., et al. “Interspecies transmission and emergence of novel viruses: lessons from bats and birds”. Trends in Microbiology 10 (2013): 544-555.
  4. Zhang C., et al. “Liver injury in COVID-19: management and challenges”. The Lancet Gastroenterology and Hepatology 5 (2020): 428-430.
  5. Gu J., et al. “COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission”. Gastroenterology (2020): 158.
  6. Guan WJ., et al. “Clinical Characteristics of Coronavirus Disease 2019 in China”. The New England Journal of Medicine 382 (2020): 1708-1720.
  7. Magro C., et al. “Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases (2020).
  8. Xiao F., et al. “Evidence for gastrointestinal infection of SARS-CoV-2”. Gastroenterology (2020).
  9. MW Jones and T Ferguson. “Acalculous cholecystitis”. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2020).
  10. Cárdenas Quirós MF. “Acute acalculous cholecystitis”. Revista Medica Sinergia 6 (2018): 3-8.
  11. E Mattone., et al. “Acute acalculous cholecystitis on a COVID-19 patient: a case report”. Annals of Medicine and Surgery 58 (2020): 73.
  12. T Waltuch., et al. “Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department”. American Journal of Emergency Medicine (2020).
  13. E Asti., et al. “Gangrenous cholecystitis during hospitalization for SARS-CoV2 infection”. Updates in Surgery 3 (2020): 917-919.
  14. A Bruni., et al. “Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis”. World Journal of Emergency Surgery 1 (2020): 43.
  15. De Oliveira JSA., et al. “Acute acalculous cholecystitis in critically ill patients risk factors diagnosis and treatment strategies”. Journal of the Pancreas 17.6 (2016): 580-586.
  16. Asociación Mexicana de Cirugía General AC. Clinical practice guide: Cholecystitis. Mexico: AMCG (2014).
  17. J Roy., et al. “Acute acalculous cholecystitis in a patient with COVID-19 and a LVAD”. Journal of Cardiac Failure 7 (2020): 639.
  18. Agresta F., et al. “Laparoscopic cholecystectomy: consensus conference-based guidelines”. Langenbeck's Archives of Surgery 400 (2015): 429-453.
  19. Ansaloni L., et al. “2016 WSES guidelines on acute calculous cholecystitis”. World Journal of Emergency Surgery (2016).
  20. Agresta F., et al. “Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)”. Surgical Endoscopy 26 (2012): 2134-2164.
  21. Coccolini F., et al. “SARS-CoV-2 is present in peritoneal fluid in COVID-19 patients”. Annals of Surgery (2020).
  22. Mintz Y., et al. “A low cost, safe and effective method for smoke evacuation in laparoscopic surgery for suspected coronavirus patients”. Annals of Surgery (2020).
Citation: José Alberto Martinez Valdes., et al. “Necrotized Acalculous Cholecystitis Associated with SARS-CoV2 (COVID-19)”. EC Gastroenterology and Digestive System 8.5 (2021): 69-76.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


May Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the May issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before May 21, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk