• COVID
• SARS-CoV-2
• acalculous cholecystitis
• gallbladder

• Adult
• Humans
• COVID-19
• SARS-CoV-2/metabolism
• Acalculous Cholecystitis/diagnosis
• Peptidyl-Dipeptidase A/metabolism
• Cholecystitis, Acute
• Cholecystitis

• COVID-19
• acute non-calculous cholecystitis
• complications of COVID-19
• coronavirus infection

• Humans
• Aged
• Adult
• COVID-19/complications
• Cholecystitis, Acute/diagnosis
• Cholecystitis, Acute/etiology
• Cholecystitis, Acute/surgery

• acute abdomen
• covid-19
• sars-cov-2
• abdominal pain
• abdome agudo
• dor abdominal

• Humans
• COVID-19/complications
• SARS-CoV-2
• Abdomen, Acute/etiology
• Abdominal Pain/etiology
• Appendicitis/complications
• Appendicitis/surgery

• Humans
• Gallstones/complications
• COVID-19
• Biliary Tract
• Liver
• Cholestasis

• IK6 BX005226 BLRD VA
• R01 DK054811 NIDDK NIH HHS
• R01 DK119421 NIDDK NIH HHS
• I01 BX003031 BLRD VA
• R01 DK062975 NIDDK NIH HHS
• IK2 BX005306 BLRD VA
• R01 AA028711 NIAAA NIH HHS
• R01 DK115184 NIDDK NIH HHS
• R01 DK107310 NIDDK NIH HHS
• R01 DK076898 NIDDK NIH HHS
• R01 DK110035 NIDDK NIH HHS
• I01 BX000574 BLRD VA
• R01 DK108959 NIDDK NIH HHS
• IK6 BX004601 BLRD VA

• 30-day readmission
• Acute pancreatitis
• COVID-19
• GI bleeding
• Intestinal obstruction

• COVID-19
• Review
• SARS-CoV-2
• Safety
• Surgery

• Acute acalculous cholecystitis
• Biliary complications
• COVID-19
• Gangrenous gallbladder
• SARS-CoV-2
• Systematic review

• sars-cov-2
• gastrointestinal tract
• covid-19
• pathology
• acute hepatitis
• post–covid-19 cholangiopathy
• pancreas

• COVID-19 infection
• Chronic COVID
• Gastrointestinal
• Hepatobiliary
• Long COVID
• Pandemic

• COVID-19
• Cholecystitis
• GI surgery
• Mesenteric ischemia
• Pancreatitis

• Adults
• Biliary tract diseases
• COVID-19
• Fatty liver
• Hepatic infarction
• Hepatomegaly
• Infection
• Liver
• Liver diseases
• Liver failure
• Magnetic resonance imaging
• Pediatrics
• SARS-CoV-2
• Ultrasonography
• X-Ray computed tomography

• Humans
• COVID-19
• Liver Diseases
• Radiography
• Thrombosis
• COVID-19 Testing

The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in December 2019, in Wuhan, China. The virus was rapidly spread worldwide, causing coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is presented, usually, with typical respiratory symptoms (i.e., dyspnea, cough) and fever, extrapulmonary manifestations are also encountered. Liver injury is a common feature in patients with COVID-19 and ranges from mild and temporary elevation of liver enzymes to severe liver injury and, even, acute liver failure. The pathogenesis of liver damage is not clearly defined; multiple mechanisms contribute to liver disorder, including direct cytopathic viral effect, cytokine storm and immune-mediated hepatitis, hypoxic injury, and drug-induced liver toxicity. Patients with underlying chronic liver disease (i.e., cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID-19 and further liver deterioration, and, as a consequence, certain issues should be considered during disease management. The aim of this review is to present the prevalence, clinical manifestation and pathophysiological mechanisms of liver injury in patients with SARS-CoV-2 infection. Moreover, we overview the association between chronic liver disease and SARS-CoV-2 infection and we briefly discuss the management of liver injury during COVID-19.

• COVID-19
• Liver injury
• Cytokine storm
• Hypoxic hepatitis
• Drug-induced liver injury
• Chronic liver disease

• Humans
• COVID-19
• SARS-CoV-2
• Carcinoma, Hepatocellular
• Liver Neoplasms

• COVID-19
• SARS-CoV-2
• cholangitis
• chronic liver disease
• hepatitis
• liver cirrhosis

• Humans
• SARS-CoV-2
• COVID-19/complications
• Peptidyl-Dipeptidase A
• Liver Diseases/complications
• Liver Cirrhosis

• COVID-19
• cirrhosis
• liver transplantation

• COVID-19
• COVID-19 Vaccines
• Cytokines
• Humans
• Liver Cirrhosis/epidemiology
• Liver Cirrhosis/etiology
• Liver Diseases/complications
• SARS-CoV-2

• 102176/B/13/Z Wellcome Trust

• Bacteremia
• Bloodstream infection
• COVID-19
• Enterococcus
• ICU-acquired

• Aged
• Humans
• Male
• Cohort Studies
• COVID-19/epidemiology
• Critical Illness/epidemiology
• Cross Infection/epidemiology
• Intensive Care Units
• Sepsis/epidemiology

• MR/V006118/1 Medical Research Council
• P4P4PM_194449 Swiss National Science Foundation
• European society of Intensive Care Medicine
• European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
• Norva Dahlia foundation and the Redcliffe Hospital Private Practice Trust Fund

• Clinical trials
• Long-COVID
• Pathophysiology
• Post-COVID syndrome
• Post-acute COVID syndrome

• COVID-19/complications
• COVID-19/epidemiology
• Hospitalization
• Humans
• Risk Factors
• COVID-19 Drug Treatment
• Post-Acute COVID-19 Syndrome

• coronavirus disease 2019
• acute acalculous cholecystitis
• laparoscopic cholecystectomy

• Acalculous Cholecystitis/diagnosis
• Acalculous Cholecystitis/etiology
• COVID-19/complications
• Cholecystectomy, Laparoscopic
• Humans
• Male
• Middle Aged
• Public Health
• SARS-CoV-2

There is insufficient research on digestive symptoms and outcomes following coronavirus disease (COVID-19) vaccination. We aimed to investigate digestive symptoms and related complications among South Koreans who were administered COVID-19 vaccines.

Forty-six patients (men: 22, women: 24) with a median age of 68 years (interquartile range:55.5, 73.8 years) who experienced digestive symptoms following COVID-19 vaccination between March 1 and July 30, 2021, were included. This retrospective single-center study collected information on clinical symptoms, laboratory tests, imaging results, comorbidities, complications, treatment type, and prognosis.

Thirty-three (71.7%), nine (19.6%), and three (6.5%) patients were administered AZD1222 (AstraZeneca), BNT162b2 (Pfizer/BioNTech), and JNJ-78436735 (Johnson and Johnson) vaccines, respectively. Patients were classified with mild (25 patients, 54.3%), moderate (five patients, 10.9%), and severe (16 patients, 34.8%) based on disease severity. Digestive symptoms included abdominal pain, diarrhea, dyspepsia, and nausea, which usually developed within 1 day (78.3%) following the first vaccination. In total, 14 (30.4%) patients experienced only gastrointestinal symptoms, whereas 32 (69.6%) experienced non-gastrointestinal symptoms. Complications included enterocolitis (76%), acute kidney injury (9%), anaphylactoid reaction (2%), and duodenal perforation (2%).

COVID-19 vaccines caused digestive symptoms and other complications that ranged from mild to severe. While further validation is required, our results suggest that monitoring digestive symptoms following COVID-19 vaccination can help detect rather severe complications that require medical intervention.

• Adverse reaction
• COVID-19
• Digestive symptoms
• Vaccine

The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.

To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes.

This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis.

Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03).

In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.

• COVID-19
• SARS-CoV-2
• Coronavirus
• Sepsis
• Drainage
• Abscess

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.

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.

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).

COVID-19 patients with acute cholecystitis had difficult cholecystectomies, high rates of ICU admission, and a prolonged LOS.

• COVID-19
• SARS-CoV-2
• Cholecystectomy in COVID-19
• Acute cholecysti- tis in COVID-19
• Case report

• COVID-19
• Cholecystitis
• Delivery of Health Care
• Humans
• SARS-CoV-2

Emerging data indicate that gastrointestinal disorders, in addition to pulmonary dysfunction, are also hallmarks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

A 42-year-old man with maintenance hemodialysis developed high fever and dyspnea. He was positive for SARS-CoV-2 and was diagnosed with pneumonia. After treatment for SARS-CoV-2, his respiratory condition improved. However, he developed right upper quadrant pain with elevated inflammatory markers (white blood cells, 21,160/μL; c-reactive protein, 163.9 mg/L) on the 13th day. Abdominal computed tomography revealed acute acalculous cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed together with antibiotic therapy, which resulted in improvement of symptoms. Laparoscopic cholecystectomy was performed 36 days after PTGBD.

We report a rare case of acute acalculous cholecystitis (AAC) following pneumonia caused by SARS-CoV-2 infection. We also conducted a literature search to characterize SARS-CoV-2-related cholecystitis. Infection with SARS-CoV-2 is an important trigger for AAC, and appropriate therapeutic alternatives should be cautiously selected according to individual cases.

•

We experienced a case of acute acalculous cholecystitis (AAC) following COVID-19.

A 41-year-old female presented with an 8-month history of right upper quadrant pain, exacerbated by ingestion of saturated fats. The patient was positive for antibodies to Coxsackievirus serotype B4, established by an investigation incited by an acute episode of pleurodynia 8 months before the current presentation. Imaging studies including a hepatobiliary iminodiacetic acid scan showed no gallbladder structural or functional abnormalities. Laboratory studies indicated pancreatic enzyme insufficiency associated with below-normal lipase and amylase levels. Patient symptomology was consistent with cholecystitis with positive Murphy’s sign, so cholecystectomy was recommended. Post-surgery pathological report confirmed chronic acalculous cholecystitis. Patient demonstrated full recovery, indicated by return of normal pancreatic enzymes levels and resolution of abdominal pain.

• Abdominal imaging
• COVID-19
• Multisystem inflammatory syndrome

• Abdomen
• Adult
• COVID-19/complications
• Child
• Humans
• SARS-CoV-2
• Systemic Inflammatory Response Syndrome

About 20% of COVID-19 patients can have digestive symptoms, apart from the typical chest-related symptoms, and 10% of patients may have only gastrointestinal (GI) symptoms during their entire disease course.

The purpose of this study was to describe the spectrum of abdominal computed tomographic (CT) findings in a cohort of 15 COVID-19 patients (confirmed on reverse transcription polymerase chain reaction (RT-PCR)) who presented with various GI presentations without preceding respiratory symptoms.

A total of 93 patients with COVID-19 (confirmed on RT-PCR) who underwent CT imaging (between September 28, 2020 and March 20, 2021) in our center were retrospectively searched from the existing database. Among those, 15 patients having index presentation with abdominal symptoms and underwent CT abdomen were further evaluated.

Biliary stasis in the form of distended gallbladder and wall thickening was the most common finding, seen in 66.7% (n = 10) patients, followed by bowel wall thickening. Small bowel and large bowel thickenings were seen in 26.7% (n = 4) and 20% (n = 3) patients, respectively. Other findings include fluid-filled colon (n = 1), mesenteric venous thrombosis (MVT) (n = 2), paper-thin bowel wall and pneumatosis (n = 1), acute pancreatitis (n = 1), and ascites (n = 2). One patient who presented with abdominal pain did not show any obvious imaging findings on CT.

Patients with COVID-19 can present with initial GI symptoms preceding typical respiratory symptoms. CT imaging helps in identifying the GI involvement, to rule out alternate etiologies, and also aids in appropriate management planning.

Patel RK, Chandel K, Mittal S, et al. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepato-Gastroenterol 2021;11(2):76–80.

• COVID 19
• Cholecystitis
• Gastrointestinal
• Mesenteric venous thrombosis

• Autoimmunity
• COVID-19
• CYP450
• FoxP3
• Inflammation
• NF-κB
• RIG-I
• RORγt
• Retinoic acid
• Retinoid signaling
• Retinol
• Th17
• Treg
• Type-I IFN
• Vitamin A
• Vitamin D

• COVID-19/immunology
• COVID-19/metabolism
• COVID-19/pathology
• COVID-19/virology
• Central Nervous System/metabolism
• DEAD Box Protein 58/metabolism
• Humans
• Immune Tolerance
• Interferon Type I/metabolism
• Receptors, Immunologic/metabolism
• SARS-CoV-2/genetics
• SARS-CoV-2/isolation & purification
• Signal Transduction/physiology
• T-Lymphocytes, Regulatory/immunology
• T-Lymphocytes, Regulatory/metabolism
• Viral Tropism/physiology
• Vitamin A/blood
• Vitamin A/metabolism

The global pandemic of Coronavirus 2019 (COVID-19) or SARS-CoV-2 has numerous manifestations in different organ systems. It is known that SARS-CoV-2 infects the hepatobiliary system leading to presentations such as acute cholecystitis, choledocholithiasis and hepatitis. Although the exact mechanism of the underlying pathology is unknown, it is likely attributed by the tropism of the virus to the ACE2 receptors in the hepatocytes and bile duct cells resulting in a cytokine storm that precipitates as systemic symptoms from acute COVID-19 infection. In this case report we present a case of a 47-year-old male who presented with signs consistent with acute cholecystitis. It was confirmed on ultrasound and he was incidentally found to be positive for COVID-19 on routine surveillance testing. He was asymptomatic and was being prepped for cholecystectomy, but developed an acute elevation of liver enzymes suggesting choledocholithiasis. After endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy the patient experienced a rapid normalization of liver enzymes and improvement of his abdominal symptoms.

•

SARS-CoV-2 can infiltrate gallbladder wall cells, mimicking acute cholecystitis and choledocholithiasis.

• COVID-19
• Cholecystitis
• Cholidocolithais
• Coronavirus 2019
• SARS-CoV-2

While primarily a respiratory disease, COVID-19 can affect several organ systems and has been recently linked to cases of acalculous cholecystitis. We present a previously healthy elderly patient who presented to the emergency department with sepsis and was found to have COVID-19 after initially testing negative on PCR, along with suspected concomitant acalculous gangrenous cholecystitis. The patient passed away before any surgical intervention could be made. This case aims to discuss the potential relationship between acalculous cholecystitis and COVID-19.

• COVID-19
• SARS-CoV-2
• acalculous cholecystitis
• gangrenous cholecystitis

• Abdominal imaging
• Computed tomography
• Gastrointestinal
• Radiology

Since the coronavirus disease 2019 (COVID-19) pandemic has hit the entire world, there is ample knowledge regarding its clinical course and prognostic biomarkers. Still, the pathophysiology of COVID-19 is poorly understood. Since the first guidelines published in February 2020 for autopsy of both confirmed and suspected COVID-19 cases, there has been an increasing number of autopsies and literature reporting histopathological findings. However, our knowledge about the immunological response of various organ systems to the virus, as well as response patterns, is inadequate but is essential to understand and initiate timely and targeted antiviral, anti-inflammatory, or anticoagulative therapy. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily considered a respiratory virus, current evidence shows that it causes life-threatening complications in almost all organ systems including the heart, brain, kidney, spleen, liver, and eyes. Hence, in this article, we reviewed the published case reports and case series in order to increase our understanding of COVID-19 pathophysiology. The main histopathological findings of the lungs include diffuse alveolar damage with activated type II pneumocytes, fibroblasts, protein-rich exudate, and hyaline membranes. Other significant histopathological findings include cardiomegaly, right ventricular dilation, splenic pulp atrophy, kidneys with severe podocytopathy, and collapsing glomerulopathy, and the brain showed hypoxic changes in the cerebellum and cerebrum. Furthermore, in this review, we also explained different pathological findings of SARS-CoV and MERS and compared them to SARS-CoV-2. This comprehensive review will improve our understanding of COVID-19 pathophysiology and various disease stages, hence promoting the application of targeted therapy.

• COVID-19
• Coronavirus
• Diffuse alveolar damage
• Pathology
• SARS-CoV-2

• acute abdomen
• bowel obstruction
• covid -19
• ct scan
• hernia
• internal hernia
• intestinal obstruction
• left paraduodenal hernia
• paraduodenal hernia
• treitz hernia

Although the Coronavirus Disease 2019 (COVID-19) infection mainly affects the lung, its gastrointestinal (GI) involvements are also well-known, especially hepatic involvement presenting as mild to moderate transaminitis. However, COVID-19 infection presenting with gall bladder involvement with acalculous cholecystitis is extremely rare in the medical literature. So far, only two cases have been reported, and herein, we are reporting the third case of a patient who developed COVID-19 presenting as an acute acalculous cholecystitis.

• acalculus cholecystitis
• acute cholecystitis
• covid 19
• covid 19 gi manifestation
• covid 19 pneumonia

• ACLF
• Cirrhosis
• Transaminitis
• Vaccine

The Coronavirus Disease-19 (COVID-19) pandemic has caused more than 100,000,000 cases of coronavirus infection in the world in just a year, of which there were 2 million deaths. Its clinical picture is characterized by pulmonary involvement that culminates, in the most severe cases, in acute respiratory distress syndrome (ARDS). However, COVID-19 affects other organs and systems, including cardiovascular, urinary, gastrointestinal, and nervous systems. Currently, unique-drug therapy is not supported by international guidelines. In this context, it is important to resort to adjuvant therapies in combination with traditional pharmacological treatments. Among natural bioactive compounds, palmitoylethanolamide (PEA) seems to have potentially beneficial effects. In fact, the Food and Drug Administration (FDA) authorized an ongoing clinical trial with ultramicronized (um)-PEA as an add-on therapy in the treatment of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. In support of this hypothesis, in vitro and in vivo studies have highlighted the immunomodulatory, anti-inflammatory, neuroprotective and pain-relieving effects of PEA, especially in its um form. The purpose of this review is to highlight the potential use of um-PEA as an adjuvant treatment in SARS-CoV-2 infection.

• COVID-19
• SARS-CoV-2
• adjuvant treatment
• neuroinflammation
• organ damage
• ultramicronized palmitoylethanolamide

• ACE2
• COVID-19
• SARS-CoV-2
• diarrhea
• enteric nervous system
• gastrointestinal
• gut microbiota
• pandemic

• Animals
• COVID-19/complications
• COVID-19/physiopathology
• Diarrhea/etiology
• Diarrhea/physiopathology
• Diarrhea/virology
• Dysbiosis/etiology
• Dysbiosis/physiopathology
• Dysbiosis/virology
• Enteric Nervous System/physiopathology
• Enteric Nervous System/virology
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/physiopathology
• Gastrointestinal Diseases/virology
• Gastrointestinal Microbiome/physiology
• Gastrointestinal Tract/physiopathology
• Gastrointestinal Tract/virology
• Humans
• Liver Diseases/etiology
• Liver Diseases/physiopathology
• Liver Diseases/virology
• Pancreatic Diseases/etiology
• Pancreatic Diseases/physiopathology
• Pancreatic Diseases/virology

• COVID-19
• GI
• SARS-CoV-2
• anal swab
• digestive system
• epidemiology
• liver

• Droplet Digital PCR
• RNA quantification
• RT-PCR
• SARS-CoV-2
• body compartment

• n.a. Vironet C Foundation
• n.a. Aviralia Foundation

• COVID-19
• Endoscopy
• Gastrointestinal tract
• Inflammatory bowel disease
• Liver
• Management
• Pancreas
• Pathophysiology
• Review

• COVID-19/complications
• COVID-19/epidemiology
• COVID-19/virology
• Gastroenterologists
• Gastrointestinal Diseases/drug therapy
• Gastrointestinal Diseases/virology
• Humans
• Inflammatory Bowel Diseases/virology
• SARS-CoV-2/physiology
• Virus Internalization