В этих случаях, желчекаменной болезни не было. А вот холецистит развился до гангрены. Врачи предполагают, что либо из-за прямой атаки коронавируса (тк и в печени и желчном есть АЕС2 рецепторы), вызвавшей повреждения и воспаление, либо из-за микротромбоза, приведшего к нарушению кровоснабжения, и некрозу и воспалению тканей органа.
The hospital said five recovered Covid patients — four men and a woman, ages between 37 and 75 — returned in the past two months, and four of them had holes in their gall bladder, reported the Hindustan Times. "Gall bladder inflammation without stone is usually seen in patients with HIV, those who have received nutrition through IV, prolonged fasting, those who have been in the intensive care unit for long, and those who have had an accident or burns," Dr. Anil Arora of Sir Ganga Ram Hospital told the Hindustan Times. "(These) patients did not have these factors; they developed the acute inflammation nearly two months after recovering from COVID-19 and not during their hospital stay." The doctor added that the patients had severe gallbladder inflammation without gallstones, which resulted in gangrene of the organ. Pathologists in the hospital found the patients had severe inflammation and injury due to lack of blood supply along with damage to the vessels. This prompted doctors to believe that the Sars-CoV-2 virus might be causing the condition. “The Sars-CoV-2 virus enters through the respiratory system and affects the lungs the most as it has a high number of ACE-2 receptors that the virus uses to bind to human cells. After lungs, the gastrointestinal tract and the biliary system (bile duct, gall bladder and associated structures) have the highest ACE-2 receptors. We think the virus might be attaching to the gall bladder lining and dysregulating the immune system, causing injury to the gall bladder,” said Dr. Arora. The condition called "acalculous cholecystitis" was confirmed through ultrasound and CT scan, and has a high morbidity rate of up to 30-60%. The symptoms included fever, pain in the right upper quadrant of the abdomen and vomiting. All of patients required emergency surgery.
Конечно, эти случаи критические и ярко выраженные. Наверное, крайняя степень поражения,- что не отменяет более мягкие формы воспаления, менее клинически выраженные, по тем же причинам.