Spontaneous gallbladder perforation in patient with COVID-19—a case report and review of literature

Abstract

The Coronavirus 2019 disease (COVID-19) originated in Wuhan in China in December 2019 has evolved over the past year in terms of its pathophysiology, clinical presentation, imaging manifestations and management strategies. Though COVID-19 is predominantly a pulmonary illness, it is now established to show widespread extra pulmonary involvement. Gastrointestinal manifestations of COVID-19 are also well known. COVID-19 infection presenting with the involvement of gallbladder is extremely rare in medical literature. Gallbladder perforation should be thought of in COVID-19 patients complaining of with acute abdomen in with acute cholecystitis.

Spontaneous Gallbladder Perforation: A Case Report

“…In elderly patients, spontaneous gallbladder perforation can result from a decrease in its blood supply, which can be due to atherosclerosis, focal vasospasm, or localized vasculitis [3]. Acute biliary emergencies that involve the gallbladder make up around 2% of cases, and due to the high mortality and morbidity rates associated with them, they pose a challenge in terms of treatment [4].…”

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

“…Microscopic evaluation of these cholecystectomy specimens revealed extensive mucosal ulceration, mucosal to transmural necrosis, hemorrhage, widespread fibroblastic proliferation, transmural inflammatory cell infiltrate, vasculitis with thrombosis of medium-sized vessels, hemorrhagic infarction of the gallbladder wall, and hypertrophy of nerve fibers 46,90–94 . Spontaneous perforation of the gallbladder in the setting of COVID-19 has been described in a case of acute cholecystitis; that showed ischemic mucosal necrosis upon microscopic evaluation of the cholecystectomy specimen 95 . SARS-CoV-2 nucleocapsid protein and RNA were demonstrated in the gallbladder wall in 2 studies, one of which was for 2 COVID-19 patients who presented with features of acute acalculous cholecystitis and had a microscopically uninflamed gallbladder 46,96 …”

“…46,[90][91][92][93][94] Spontaneous perforation of the gallbladder in the setting of COVID-19 has been described in a case of acute cholecystitis; that showed ischemic mucosal necrosis upon microscopic evaluation of the cholecystectomy specimen. 95 SARS-CoV-2 nucleocapsid protein and RNA were demonstrated in the gallbladder wall in 2 studies, one of which was for 2 COVID-19 patients who presented with features of acute acalculous cholecystitis and had a microscopically uninflamed gallbladder. 46,96…”

Laparoscopic cholecystectomy for acalculous, gangrenous cholecystitis on an outpatient COVID-19 adult: a case report

“…Literature reports suggested a more aggressive presentation of cholecystitis, regardless of the presence or not of cholelithiasis [ 1 ]. These associated biliary manifestations are considered to be the result of a dysregulated inflammatory response, rather than a direct viral injury [ 2 , 3 ].…”