COVID-19 induced haemobilia: a novel entity

Abstract

Hemobilia which is firstly described in 1948 is a rare cause of gastrointestinal bleeding. Since its main clinic takes time to occur and may cause mortality, early diagnosis and management have a great importance. Almost for 3 years, the world has been facing with an unknown viral infection called COVID-19 whose clinic changes from asymptomatic respiratory infection to symptoms associated with multiple system involvement. The clinical presentation of Covid-19 infection varies tremendously depending on the severity of the illness. In this report, we present the first two cases of severe COVID-19 induced hemobilia.

Coronavirus Disease in the Abdomen

“…COVID-19 patients with severe LFT abnormalities have a worse prognosis than those without LFT abnormalities, including significantly higher rates of ICU admission, intubation, renal replacement therapy, and mortality [ 4 , 7 , 37 ]. Hepatobiliary abnormalities detected by imaging and attributed to COVID-19 include cholestasis, acute cholecystitis, hemobilia, periportal edema, hepatomegaly, and secondary sclerosing cholangitis [ 10 , 14 , 15 , 18 , 21 , 38 , 39 ]. As with bowel abnormalities, the imaging manifestations of gallbladder and liver inflammation are nonspecific and include findings such as gallbladder distension and wall thickening, hepatomegaly, and periportal edema [ 14 , 39 ].…”

“…Hemorrhage in the abdomen of COVID-19 patients without an alternative cause ( Fig. 9 ) has also been reported, including intraperitoneal hemorrhage from organ splenic thrombosis, hemobilia, and hematuria [ 18 , 21 , 57 , 60 ]. Dual-energy CT performed in the setting of vascular pathology or bleeding can provide radiation dose reduction by eliminating the need for separate unenhanced acquisition and instead of using virtual unenhanced reconstructions [ 43 ].…”

“…Numerous abdominal manifestations have been reported in patients with coronavirus disease 2019 (COVID-19), including involvement of the luminal gastrointestinal (GI) tract, hepatobiliary system, pancreas, kidneys, spleen, and blood vessels. Specific COVID-19 related pathologic entities described in the literature within these abdominal organ systems include ileus, Ogilvie syndrome, GI bleeding, bowel ischemia, gastric and bowel perforation, liver function abnormalities, acute hepatitis, fulminant liver failure, cholestasis, cholecystitis, secondary sclerosing cholangitis, hemobilia, pancreatitis, acute renal dysfunction, proteinuria, hematuria, splenomegaly, ascites, and arterial, portal venous, and systemic venous thrombosis [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ].…”