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


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


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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.

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