Subject(s)
COVID-19 , Cholangitis , Liver Cirrhosis, Biliary , Humans , SARS-CoV-2 , Cholangitis/diagnosisABSTRACT
INTRODUCTION: Liver chemistry abnormalities are a frequent manifestation of coronavirus disease 2019 (COVID-19) but are usually transient and resolve with disease resolution. METHODS: We describe the clinical course and histologic features of 3 adults who developed prolonged and severe cholestasis during recovery from critical cardiopulmonary COVID-19. RESULTS: These patients had clinical and histologic features similar to secondary sclerosing cholangitis of the critically ill patient, but with unique histologic features including severe cholangiocyte injury and intrahepatic microangiopathy suggestive of direct hepatic injury from COVID-19. DISCUSSION: We believe that these cases constitute a novel severe post-COVID-19 cholangiopathy with potential for long-term hepatic morbidity.
Subject(s)
COVID-19/complications , Cholangitis , Liver Function Tests/methods , Liver , Adult , Biopsy/methods , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangiopancreatography, Magnetic Resonance/methods , Cholangitis/diagnosis , Cholangitis/virology , Critical Care/methods , Critical Illness , Diagnosis, Differential , Endothelial Cells/pathology , Female , Humans , Liver/blood supply , Liver/diagnostic imaging , Liver/pathology , Male , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Severity of Illness Index , Post-Acute COVID-19 SyndromeABSTRACT
Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.
Subject(s)
Algorithms , Betacoronavirus , Coronavirus Infections/epidemiology , Emergency Service, Hospital , Endoscopy , Patient Selection , Pneumonia, Viral/epidemiology , COVID-19 , Cholangitis/diagnosis , Cholangitis/etiology , Cholangitis/therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Foreign Bodies/diagnosis , Foreign Bodies/etiology , Foreign Bodies/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Republic of Korea , Retrospective Studies , SARS-CoV-2 , Tertiary Care CentersABSTRACT
WHO declared worldwide outbreak of COVID-19 a pandemic on 11 March 2020. Healthcare authorities have temporarily stopped all elective surgical and endoscopy procedures. Nevertheless, there is a subset of patients who require emergency treatment such as aerosol-generating procedures. Herein, we would like to discuss the management of a patient diagnosed with impending biliary sepsis during COVID-19 outbreak. The highlight of the discussion is mainly concerning the advantages of concurrent use of aerosol protective barrier in addition to personal protective equipment practice, necessary precautions to be taken during endoscopy retrograde cholangiopancreatography and handling of the patient preprocedure and postprocedure.
Subject(s)
Betacoronavirus , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholangitis/diagnosis , Coronavirus Infections/prevention & control , Emergency Service, Hospital , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Adult , Aerosols , COVID-19 , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Female , Humans , SARS-CoV-2ABSTRACT
During the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak in Wuhan, China, we experienced a case of SARS-CoV-2 infection with atypical presentations in a patient with acute obstructive suppurative cholangitis (AOSC), who was initially admitted with jaundice and fever. The patient had no other typical symptoms of COVID-19 such as cough, dyspnea, nausea, vomiting, abdominal pain and diarrhea except for fever, but her epidemiological history was clear. COVID-19 was finally confirmed by repeated viral nucleic acid testing, but her repetitive lungs CT imaging findings had been atypical. After endoscopic-related operations and antiviral treatment, the patient was subsequently recovered and discharged. This particular case is being reported to provide a reference and guidance for the diagnosis and management of COVID-19 in AOSC.