Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study

Abstract

BACKGROUND Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19). AIM To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection. METHODS A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1 st and May 30 th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed. RESULTS Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%. CONCLUSION Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.

COVID-19 and Intestinal Ischemia: A Multicenter Case Series

“…However, their independence of intestinal ischemia is not apparent. The diagnosis of intestinal ischemia in COVID-19 patients with gastrointestinal manifestations should be kept in mind ( 4 ), as this condition accompanies approximately 50% chance of mortality ( 5 , 6 ) or even about two-thirds, as observed in this study. Additionally, the length of hospital stay seems to be affected by intestinal ischemia.…”

“…An association between COVID-19 and intestinal ischemia could be hypothesized based on the previous studies ( 4 – 12 ). Possible mechanisms include direct viral invasion of the intestinal and vascular epithelium via Angiotensin-Converting Enzyme 2 (ACE2) receptors ( 3 ), systemic expansion of pulmonary coagulopathy, complement-mediated vasculopathy ( 13 – 15 ), and platelet activation via binding of Spike protein to ACE2 receptor ( 16 ).…”

“…In some cases, gastrointestinal symptoms could indicate more severe pathologies, including intestinal ischemia. The reported prevalence of intestinal ischemia ranges from 0.7% in hospitalized patients with COVID-19 ( 4 ) to 10% among critically ill patients with COVID-19 ( 5 ). With a mortality of about 50%, intestinal ischemia in COVID-19 patients seems to be worth investigating ( 5 , 6 ).…”

Ischemic and hemorrhagic abdominal complications in COVID-19 patients: experience from the first Italian wave

“…Abdominal ischemic and hemorrhagic manifestations of SARS-CoV-2 have been described in literature since the first pandemic wave [ 18 – 20 ]. Contrast enhanced CT with multiphasic acquisition plays a key role in the diagnosis of these abdominal manifestations and provide to clinicians essential information to assess disease severity in COVID-19 patients.…”

“…Contrast enhanced CT with multiphasic acquisition plays a key role in the diagnosis of these abdominal manifestations and provide to clinicians essential information to assess disease severity in COVID-19 patients. The abdominal ischemic radiological findings are nonspecific, being comparable to other causes of gastrointestinal ischemia [ 18 ]. In our cohort of patients with ischemic complications only 1 out of 10 had evidence of acute vessel thrombosis.…”