COVID‐19 and gastrointestinal symptoms: A case report of a Mesenteric Large vessel obstruction

Nasseh, Souhir; Trabelsi, Med Mehdi; Oueslati, Anouer; Haloui, Nabil; Jerraya, Hichem; Nouira, Ramzi

doi:10.1002/ccr3.4235

Cited by 7 publications

(13 citation statements)

References 5 publications

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“…We also identified 30 case reports or case series [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] presenting 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings. 8 cases were previously hospitalized for COVID-19 pneumonia and under anticoagulant medication ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

“…Other clinical signs reported were nausea, anorexia, vomiting, and food intolerance [ 23 , 31 , 38 , 45 ]. However, these gastrointestinal signs are encountered in 30–40% of patients with SARS-CoV-2 infection.…”

Section: Resultsmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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“…These studies underwent full-text evaluation, and a further three studies were retrieved upon screening these studies’ references. Forty-one studies reporting on 44 patients were included in the final selection [ 14 , 16 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. Of these, 32 were case reports, and the remaining 9 were case series.…”

Section: Resultsmentioning

confidence: 99%

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

Cai,

Zhao,

Mallappa

2024

Viruses

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Objectives: COVID-19 infection confers an increased risk of coagulation dysfunction (1) predisposing to thromboembolism in many anatomical sites including the gastrointestinal tract (GIT) (2). This study investigates the clinical presentation and outcome in patients presenting with concurrent COVID-19 infection and gastrointestinal tract ischaemia. Furthermore, differentiation and comparisons are drawn between those with arterial and venous aetiology for mesenteric ischaemia. Methods: A systematic search was undertaken on EMBASE, PubMed, and MEDLINE. Two independent reviewers screened titles, abstracts, and full-text articles according to the inclusion criteria and extracted relevant data. Data analyses were conducted using Excel®. Results: Forty-one studies were included in the data analyses, yielding 44 patients. Twenty-six patients had mesenteric arterial occlusion, sixteen patients had mesenteric venous occlusion, and two patients had both arterial and venous mesenteric occlusion. All patients had concurrent COVID-19 infection. The survival rate in patients with arterial aetiology was 38.5% in contrast to 68.8% in patients with venous aetiology. Twelve patients (29.3%) experienced respiratory symptoms in the community before the onset of gastrointestinal symptoms, and five (12.2%) developed gastrointestinal symptoms during their inpatient stay for COVID-19 pneumonitis. Conclusions: Acute mesenteric ischaemia presents a clinical challenge to diagnose due to its non-specific symptoms. Concurrent COVID-19 infection with its predominant respiratory symptoms adds a further challenge in recognising the non-specific symptoms of mesenteric ischaemia. Our study draws attention to the increased thromboembolic risk posed by COVID-19 infection and the need for a high index of suspicion to aid prompt diagnosis and management of acute mesenteric ischaemia, even in the post-pandemic era.

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“…Only four reports did not mention the diagnostic method 28 , 52 , 57 , 62 and there was detection of viral RNA in the intestinal mucosa of a patient through the In Situ Hybridization technique, performed due to the high clinical suspicion associated with a previously negative PCR and absence of inflammatory patterns characteristic of COVID-19 on their chest CT 23 . Fever, cough, and dyspnea were the most reported symptoms 7 , 10 , 20 , 24 , 27 , 28 , 30 - 33 , 37 - 39 , 41 , 47 , 48 , 51 , 53 , 54 , 57 - 61 .…”

Section: Resultsmentioning

confidence: 99%

Acute mesenteric ischemia and COVID-19: an integrative review of the literature

SILVA

Neto

2023

Rev. Col. Bras. Cir.

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The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was “mesenteric ischemia in patients with COVID-19: coincidence or association?”. After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.

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COVID‐19 and gastrointestinal symptoms: A case report of a Mesenteric Large vessel obstruction

Cited by 7 publications

References 5 publications

Acute Mesenteric Ischemia in COVID-19 Patients

Acute Mesenteric Ischemia in COVID-19 Patients

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

Acute mesenteric ischemia and COVID-19: an integrative review of the literature

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