COVID-19 and Intestinal Ischemia: A Multicenter Case Series

Frontiers in Medicine

article

Maryam Sarkardeh¹  Elahe Meftah³  Narjes Mohammadzadeh⁴  Javad Koushki²  Zahra Sadrzadeh² 

[1] Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences;Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences;Students' Scientific Research Center, Tehran University of Medical Sciences;Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences

关键词: coronavirus disease 2019;    COVID-19;    SARS-CoV-2;    bowel necrosis;    mesenteric ischemia;    intestinal perforation;    case series;   

DOI  :  10.3389/fmed.2022.879996

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction Gastrointestinal symptoms are common among COVID-19 patients. Although gastrointestinal involvements are mostly benign, they rarely indicate a severe pathology like intestinal ischemia. The present case series describes 21 patients with bowel ischemia, necrosis, or perforation. Methods The present case series was conducted from April 2020 to February 2022 in the surgical wards of two Iranian hospitals. We retrospectively included adult patients with concomitant COVID-19 and intestinal ischemia. Primary outcomes were defined as the length of stay and survival. Results Twenty-four patients with a median age of 61.5 years were included in the study. Sixteen (67%) patients were male, and 13 (54%) were without any comorbidities. Macrovascular mesenteric ischemia was not identified in 21 patients (87.5%). Gastrointestinal manifestations appeared on the median of seven days (range 2–21) after the diagnosis of COVID-19, with the most common symptom being abdominal pain. All the patients had a significantly elevated C-Reactive Protein prior to surgery, ranging from 68 to 362. D-dimer was measured in eight patients and was significantly elevated, ranging from 1,878 to over 5,000 ng/mL. One patient was managed conservatively due to a good clinical condition. Except for one patient with angioinvasive mucormycosis and one other with leukocytoclastic vasculitis, pathologic evaluation revealed general features of intestinal necrosis, including ulcer, hemorrhage, necrosis, neutrophilic infiltration (in seven patients), neutrophilic abscess (in four patients), and edema. Bowel necrosis accompanied mortality of 15 (62.5%) patients and a median of 6.5 days of hospital stay. Conclusion Intestinal ischemia in COVID-19 patients is associated with a high mortality rate. Further research is needed to elucidate the dynamics of intestinal ischemia in the setting of COVID-19.

【 授权许可】

CC BY