Case Report: Ischemic Colitis in Severe COVID-19 Pneumonia: An Unforeseen Gastrointestinal Complication

Paul, Theresa; Joy, Antony Raphel; Alsoub, Hussam; Parambil, Jessiya Veliyankodan

doi:10.4269/ajtmh.20-1262

Cited by 25 publications

(28 citation statements)

References 22 publications

(21 reference statements)

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“…Ischemic colitis as a consequence of COVID-19 appears to occur in patients presenting with severe respiratory illness. Of the six cases available in the literature, four died as a result of ischemic colitis, and those that did survive either received tocilizumab [ 16 ] or underwent the creation of an ostomy in order to prevent perforation [ 17 ]. The mechanism for the development of ischemic colitis in COVID-19 seems multifaceted.…”

Section: Discussionmentioning

confidence: 99%

Colonic Ileus, Distension, and Ischemia Due to COVID-19-Related Colitis: A Case Report and Literature Review

Shaikh¹,

Patel²,

Makker³

et al. 2021

Cureus

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Coronavirus disease 2019 (COVID-19) predominantly presents with respiratory symptoms, however, the involvement of the gastrointestinal system has also been reported. Isolated gastrointestinal manifestation due to COVID-19 presenting as colonic distension is uncommon. Colonic ileus from COVID-19 infection presents as dilatation on imaging, with the risk of subsequent ischemia and perforation if not recognized and treated promptly. There is no consensus on the treatment modality for COVID-19-related colitis, however, COVID-19-targeted medications in conjunction with surgical intervention have been performed for management. We present a case of a 73-year-old man who presented with abdominal pain, distention, and diarrhea. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was found to have marked dilatation of the colon on imaging. He was initially given convalescent plasma to reduce inflammatory markers, as tocilizumab was contraindicated due to suspected bowel obstruction. Once more stable, he underwent surgical intervention followed by tocilizumab infusion. Pathological specimens of the colon demonstrated hemorrhagic colitis with microthrombi suggestive of COVID-19-related colitis. Recognizing COVID-19-related colitis allows for timely diagnosis and management with targeted interventions in addition to surgery, which may prevent perforation. We suggest convalescent plasma followed by the formation of colostomy and finally infusion of tocilizumab as a feasible option for the treatment of COVID-19-related colitis. However, further research is needed in order to fully understand this entity and provide guidance for its management.

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Section: Discussionmentioning

confidence: 99%

Colonic Ileus, Distension, and Ischemia Due to COVID-19-Related Colitis: A Case Report and Literature Review

Shaikh¹,

Patel²,

Makker³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Chan et al [13] were the first to report a case of SARS-CoV-2 infection causing ischemic colitis with high D-dimer levels and inflammatory markers, together with clinical and radiographic findings of Similarly, Paul et al [14] reported a case of severe COVID-19 pneumonia, developing ischemic colitis.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Colitis in a Covid-19 Patient

Urciuoli¹,

Guerriero

2021

Asp Biomed Clin Case Rep

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Coronavirus disease 2019 (COVID-19) is caused by a novel strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first discovered in Wuhan, China, in December 2019. The virus has quickly spread around the globe and has been declared a global pandemic by the World Health Organization. Although in COVID-19 respiratory symptoms predominate, there is a relevant body of evidence that initial symptoms and complications of COVID-19 are not limited to the pulmonary system, but can involve also the gastrointestinal tract. We report a case that presented with ischemic colitis in the setting of PCR-confirmed SARS-CoV-2 infection.

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“…Norsa et al [ 69 ] also suggested that a high level of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with arising abdominal pain because this complication could account for an increase mortality risk. Paul et al [ 70 ] discussed a case of severe COVID-19 pneumonia, developing ischemic colitis, for several reasons, including hypercoagulable state, coagulopathy leading to thromboembolic complications, and use of vasopressors in severely ill patients with hemodynamic compromise. Singh et al [ 71 ] conducted a rapid review of the current scientific literature available in PubMed to identify cases of acute mesenteric ischemia (AMI) in COVID-19 patients, and they summarized the clinical characteristics of COVID-19 patients with AMI.…”

Section: Digestive System Manifestations In Covid-19 Patientsmentioning

confidence: 99%

COVID-19 and the digestive system: A comprehensive review

Wang¹,

Yue²,

Cai³

et al. 2021

WJCC

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The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spreading at an alarming rate, and it has created an unprecedented health emergency threatening tens of millions of people worldwide. Previous studies have indicated that SARS-CoV-2 ribonucleic acid could be detected in the feces of patients even after smear-negative respiratory samples. However, demonstration of confirmed fecal-oral transmission has been difficult. Clinical studies have shown an incidence rate of gastrointestinal (GI) symptoms ranging from 2% to 79.1% in patients with COVID-19. They may precede or accompany respiratory symptoms. The most common GI symptoms included nausea, diarrhea, and abdominal pain. In addition, some patients also had liver injury, pancreatic damage, and even acute mesenteric ischemia/thrombosis. Although the incidence rates reported in different centers were quite different, the digestive system was the clinical component of the COVID-19 section. Studies have shown that angiotensin-converting enzyme 2, the receptor of SARS-CoV-2, was not only expressed in the lungs, but also in the upper esophagus, small intestine, liver, and colon. The possible mechanism of GI symptoms in COVID-19 patients may include direct viral invasion into target cells, dysregulation of angiotensin-converting enzyme 2, immune-mediated tissue injury, and gut dysbiosis caused by microbiota. Additionally, numerous experiences, guidelines, recommendations, and position statements were published or released by different organizations and societies worldwide to optimize the management practice of outpatients, inpatients, and endoscopy in the era of COVID-19. In this review, based on our previous work and relevant literature, we mainly discuss potential fecal-oral transmission, GI manifestations, abdominal imaging findings, relevant pathophysiological mechanisms, and infection control and prevention measures in the time of COVID-19.

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Case Report: Ischemic Colitis in Severe COVID-19 Pneumonia: An Unforeseen Gastrointestinal Complication

Cited by 25 publications

References 22 publications

Colonic Ileus, Distension, and Ischemia Due to COVID-19-Related Colitis: A Case Report and Literature Review

Colonic Ileus, Distension, and Ischemia Due to COVID-19-Related Colitis: A Case Report and Literature Review

Acute Ischemic Colitis in a Covid-19 Patient

COVID-19 and the digestive system: A comprehensive review

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