Post-COVID-19 Cholangiopathy: A Systematic Review.

Objectives: Post-COVID-19 cholangiopathy (PCC) is a rare but poorly understood and serious complication of COVID-19 infection. We sought to better understand the epidemiology, mechanism of action, histology, imaging findings, and outcomes of PCC. Methods: We searched PubMed, Cochrane Library, Embase, and Web of Science from December 2019 to December 2021. Mesh words used "post-Covid-19 cholangiopathy," "COVID-19 liver injury," "Covid-19 and cholangiopathy," and "COVID-19 liver disease." The data on epidemiology, mechanism of action, histology, imaging findings, and outcomes were collected. Results: PCC was reported in 30 cases during the study period. The mean (standard deviation [SD]) age was 53.7 (5). Men accounted for cases (83.3%). All patients had required intensive level of care and mechanical ventilation. Mean (SD) number of days from COVID infection to severe disease or liver disease was 63.5 (38). Peak mean (SD) alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, and total bilirubin were 2014 (831.8) U/L, 1555 (2432.8) U/L, 899.72 (1238.6) U/L, and 10.32 (9.32) mg/dl, respectively. Four patients successfully underwent liver transplantation. Conclusion: PCC is a severe and progressive complication of COVID-19 infection. More research is needed to better understand the pathophysiology and best treatment approach. Clinicians should suspect PCC in patients with cholestatic liver injury following COVID-19 infection.

Spontaneous Isolated Superior Mesenteric Artery Dissection With Thrombosis: A Case Report of a Rare Presentation of Acute Abdominal Pain.

Spontaneous isolated superior mesenteric artery dissection is a very rare vascular disease that involves the superior mesenteric artery or its branches, with an incidence as low as 0.08%. The majority of cases occur in patients of Asian descent. Due to advances in imaging modalities, particularly abdominal computed tomography angiography, the diagnosis of this disease has been increasing. Herein, we present a rare case of spontaneous isolated superior mesenteric artery dissection with thrombosis in a young male patient with no past medical history. The importance of this disease as a differential diagnosis for acute abdominal pain is emphasized.

La dissection isolée spontanée de l'artère mésentérique supérieure est une maladie vasculaire très rare qui affecte l'artère mésentérique supérieure ou ses branches, et dont l'incidence s'élève à peine à 0,08 %. La majorité des cas surviennent chez des patients d'ascendance asiatique. En raison des progrès réalisés dans les modalités d'imagerie, et en particulier de l'angiographie abdominale par tomodensitométrie, le diagnostic de cette affection est en hausse. Nous présentons ici un rare cas de dissection isolée spontanée de l'artère mésentérique supérieure avec thrombose chez un jeune patient sans antécédents médicaux. L'importance de cette maladie dans le diagnostic différentiel de la douleur abdominale aiguë est mise en évidence.

A Challenging Case of Refractory Biliary Leak in a Patient With Hydatid Liver Disease.

Hydatid liver disease (HLD) is the most common form of hydatid disease, and it is caused by a zoonotic infection with a tape worm. It is endemic mostly in sheep-farming countries and rare in the United States. Liver involvement is usually asymptomatic, but symptoms develop upon growth of the cyst leading to many complications, most common of which is intra-biliary rupture, and less likely biliary obstruction. Diagnosis is clinical, serologic and radiologic. Therapeutic approaches to HLD include surgery, anthelminthic medications and medico-surgical procedures. Here we present a case of HLD that presented in advanced stage leading to grave consequences, complicated course and difficult therapeutic options. Given the rarity of hydatid disease in Northern America, physicians have to keep high index of suspicion especially in a patient with history of travel to endemic areas, as early diagnosis and treatment is important to avoid high morbidity and mortality.

The Poisoned Heart: A Case of Takotsubo Cardiomyopathy Induced by Carbon Monoxide Poisoning.

BACKGROUND: Carbon monoxide is a common environmental toxin, and some patients present with features of cardiac injury in addition to the noxious effects of carbon monoxide poisoning. A very small fraction of those have a transient left ventricular apical ballooning syndrome or Takotsubo cardiomyopathy, both terms are used to define a syndrome that affects the systolic function of the heart. It usually presents with elevated troponin levels with or without electrocardiographic changes. Cardiac angiograms generally illustrate coronary arteries without significant obstruction. CASE REPORT: Here we report the curious case of a 37-year-old Hispanic man brought in for carbon monoxide poisoning, but found to have significantly elevated troponin levels. Echocardiogram demonstrated decreased ejection fraction of 35%. Left heart catheterization 2 days after admission revealed patent coronary arteries, improved ejection fraction to 45%, and wall motion abnormalities plus apical ballooning compatible with Takotsubo cardiomyopathy. The case is unusual because our patient differs from the classically defined elderly, postmenopausal female demographic, and did not experience an emotional crisis that could have provoked this series of events. It is also noteworthy for the fact that the only identifiable trigger was exposure to carbon monoxide. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Carbon monoxide poisoning is a common occurrence resulting in a multitude of annual emergency department visits. Given the known toxic effects of carbon monoxide poisoning on the heart, prompt cardiac workup is important to prevent overlooking a major, although rare, manifestation of carbon monoxide exposure.