Korean J Gastroenterol.  2021 Dec;78(6):353-358. 10.4166/kjg.2021.131.

Acute Necrotizing Pancreatitis and Coronavirus Disease-2019 (COVID-19)

• Aday U
• Gedik E
• Kafadar MT
• Özbek E

• KMID: 2523598
• DOI: http://doi.org/10.4166/kjg.2021.131

Abstract

Coronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV- 2) and has resulted in increased mortality worldwide. Several studies have identified the involvement of the gastrointestinal tract, respiratory tract, and other tissues. Although it has been reported that the angiotensin-converting enzyme-2 receptor affected by SARS-CoV is expressed more in the pancreas than in the lungs, the issue regarding the occurrence of pancreatitis is controversial. SARS Cov-2 rarely causes acute necrotizing pancreatitis without significantly affecting the respiratory and other systems. This paper presents a patient who underwent laparotomy due to acute necrotizing pancreatitis and hemodynamic instability caused by COVID-19 without any known risk factors.

Keyword

COVID-19; Pancreatitis; acute necrotizing; SARS-CoV-2

Figure

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  Fig. 1 Pancreatic edema (yellow arrow of A) and minimal peripancreatic fluid (red arrow of A) are observed in (A) axial and (B) coronal sections of the uncontrasted computed tomography (CT) taken after the initial diagnosis. These images were taken before laparotomy in the center where the first hospitalization was performed. (C, D) CT angiography taken in the Dicle University School of Medicine, Gastrointestinal Surgery Clinic revealed necrosis in the pancreas (yellow arrow), increased fluid extending to the perirenal area (red stars), and compresses placed in the previous laparotomy (white arrow of C, red stars of D).

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  Fig. 2 (A, B) Pleural effusion in the thorax sections of the computed tomography taken at the first diagnosis and 10 days later, but no findings associated with coronavirus disease-2019 were observed (arrows).

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  Fig. 3 Intraoperative view. (A) When the gastrocolic ligament was opened, and the stomach (white arrow) was pulled superiorly, necrosis and hemorrhage areas were observed in the pancreatic corpus (yellow arrow), lipolysis areas (black star) in the omentum, (B) hemorrhagic-necrotic penetration into the mesocolon (white arrow) was observed when the colon (yellow star) was suspended.

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  Fig. 4 Magnetic resonance pancreaticolangiography showing no extrahepatic-intrahepatic biliary duct dilatation and homogeneous contrast in the gallbladder, demonstrating no evidence of choledocholithiasis or cholelithiasis.

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  Fig. 5 (A) Contrast-enhanced computed tomography sections of the 10th day revealed regression of intra-abdominal fluids (yellow arrow) and (B) significant improvement in ischemic areas in the pancreatic parenchyma (red arrows).

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