Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report

Abstract

Clinical manifestations of Covid-19 vary widely among patients. Recent studies suggest that up to 15% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. The location of virus–host cell receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 has an important role in the pathophysiology and presentation of disease. They are expressed in the respiratory tract, as well as other organs and tissues including exocrine and endocrine pancreatic cells. These cells are therefore a possible target for the virus, which could explain the relationship between SARS-CoV-2 infection and pancreatic injury. We report a disastrous collateral effect of the Covid-19 pandemic on a 33-year-old man with chronic renal insufficiency and asymptomatic SARS-CoV-2 infection, who developed acute pancreatitis. Inflammation progressed rapidly toward necrosis and the development of a peripancreatic pseudoaneurysm which subsequently ruptured, causing death.

Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis

“…Ren et al [ 21 ] reported on their endovascular treatment of 159 patients with visceral artery aneurysms and pseudoaneurysms, with 96.9% of patients successfully treated and a 1.9% mortality rate at 30 days. Similar to our case, Mitrovic et al [ 13 , 14 , 15 ] reported successful endovascular resolution of a posterior inferior pancreaticoduodenal artery pseudoaneurysm using the sandwich technique, in which the pseudoaneurysm inflow and outflow were embolized with coils. Jang et al [ 16 ], on the other hand, embolized the pseudoaneurysm with an N-Butyl-Cyanoacrylate-lipiodol composition.…”

“…Arterial aneurysmal dilatation develops as a result of damage to the collagen structure at the arterial wall caused by atherosclerosis or hypertension, and is found with the highest incidence at the level of the abdominal aorta [ 5 , 6 , 7 , 8 , 9 ]. In contrast, arterial pseudoaneurysms are connected with trauma, surgical treatments, or the presence of malignancies, but in the case of the pancreaticoduodenal artery, the main reason is the association with chronic pancreatitis [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Although it is a rare pathology, it is lethal in the absence of intervention.…”

“…Although it is a rare pathology, it is lethal in the absence of intervention. Endovascular treatment is currently the primary approach in the event of these pathologies, with a high success rate and excellent patient progression [ 4 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. A 67-year-old woman presented with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain.…”

Surgical intervention for acute pancreatitis in the COVID-19 era

“…This observation suggests that the SARS-CoV-2 virus may cause AP[ 10 , 11 ]. A study conducted in Serbia described that 15%-19% of patients with SARS-CoV-2 infections developed gastrointestinal symptoms[ 12 , 13 ].…”

“…The location of the virus-host cell receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 plays an important role in the pathophysiology and presentation of COVID-19. These receptors are expressed in the respiratory tract, as well as other organs and tissues including exocrine and endocrine pancreatic cells[ 12 ]. Additionally, systemic inflammation may cause AP, especially in children.…”