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Editorial
. 2022 Sep 28;28(36):5240-5249.
doi: 10.3748/wjg.v28.i36.5240.

SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

Giuseppe Brisinda  1   2 , Maria Michela Chiarello  3 , Giuseppe Tropeano  4 , Gaia Altieri  4 , Caterina Puccioni  4 , Pietro Fransvea  4 , Valentina Bianchi  4
Affiliations
Editorial

SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

Giuseppe Brisinda et al. World J Gastroenterol. .

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pancreatic damage, both directly to the pancreas via angiotensin-converting enzyme 2 receptors (the transmembrane proteins required for SARS-CoV-2 entry, which are highly expressed by pancreatic cells) and indirectly through locoregional vasculitis and thrombosis. Despite that, there is no clear evidence that SARS-CoV-2 is an etiological agent of acute pancreatitis. Acute pancreatitis in coronavirus disease 2019 (COVID-19) positive patients often recognizes biliary or alcoholic etiology. The prevalence of acute pancreatitis in COVID-19 positive patients is not exactly known. However, COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative patients. Acute respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute pancreatitis. In this article, we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.

Keywords: Acute pancreatitis; Infected necrosis; Multiparametric scores; SARS-CoV-2; Severe acute pancreatitis; Step-up approach.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Abdominal computed tomography 10 d after the onset of acute pancreatitis. A: Necrotic collection, with a noticeable wall, dislocating stomach; B: Necrotic collection occupying the majority of pancreatic head and compressing the duodenum; C: Multiple collections of fluid and necrosis involving the cephalad portion of the pancreas, multiple peripancreatic collections around the spleen and the left paracolic gutter.
Figure 2
Figure 2
Abdominal computed tomography 6 mo after the onset of acute pancreatitis. A and B: The double pigtail stents positioned during the endoscopic necrosectomy through the stomach is highlighted. Endoscopic necrosectomy through the stomach was performed 4 mo prior; C: A necrotic collection is evident in the lower right quadrant of the abdomen.
Figure 3
Figure 3
Abdominal computed tomography scan documenting correct placement of lumen-apposing metal stents for the treatment of walled-off necrosis in coronavirus disease 2019 positive patient. A: Sagittal scan; B: Front scan.
Figure 4
Figure 4
Intraoperative photos. A: Surgery was performed for severe abdominal hypertension due to acute pancreatitis with necrotic collections in the retroduodenal region; B: Surgery was performed for severe abdominal hypertension due to acute pancreatitis with necrotic collections along the paracolic gutter.
See this image and copyright information in PMC

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