Intra-abdominal hypertension as a trigger of “gut failure” in SARS-CoV-2 infection: Effect of open abdomen (OA) and negative pressure therapy (NPT) on respiratory and gastrointestinal (GI) function

Grezia, Marta Di; Fransvea, Pietro; Santullo, Francesco; Tirelli, Flavio; Fico, Valeria; Mirco, Paolo; Cozza, Valerio; Greca, Antonio La; Sganga, Gabriele

doi:10.1016/j.mehy.2020.109954

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Pneumatosis or portal vein gas has been reported on abdominal CT in 6 patients [33,40,41]. An additional 3 patients were reported to have pneumatosis though the diagnostic modality used is not reported [42]. The presence of pneumatosis was reported in various regions of the GI tract, including the jejunum, ileum, caecum, and right colon.…”

Section: Abnormal Abdominal Imaging Findingsmentioning

confidence: 99%

Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review

2020

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Purpose This scoping review evaluated the currently available data related to abdominal imaging in the SARS-CoV-2 infection. Method A systematic review of MEDLINE, EMBASE, SCOPUS, and Web of Science was performed from inception to July 15, 2020 using PRISMA-ScR guidelines. The review included case reports and series discussing radiologic manifestations of SARS-CoV-2 infection in abdominal imaging studies.

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Section: Abnormal Abdominal Imaging Findingsmentioning

confidence: 99%

Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review

2020

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“…Complete resolution was reported following conservative treatment in a patient with widespread pneumatosis affecting the jejunum, proximal ileum, and caecum, for which surgery was deemed to be associated with unacceptably high morbidity[ 49 ]. In the remaining three patients, an open abdomen with negative pressure therapy was successfully performed without the need of intestinal resection[ 50 ]. The rationale behind this approach lies in the capability of either increasing gastrointestinal arterial and venous blood flow through intra-abdominal pressure reduction and dampening intestinal cytokine release in the peritoneal cavity, which might also prevent the deterioration of lung function[ 12 , 51 , 52 ].…”

Section: Resultsmentioning

confidence: 99%

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

Pirola¹,

Palermo²,

Mulinacci³

et al. 2021

WJGS

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BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common. AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies. METHODS Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”. RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman. CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.

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“…First, recent reports indicate that a new disease, such as COVID-19, and the increasing application of extra-corporeal life support in the ICU, may impact the prevalence of IAH and its complications. 58,59 Further study will follow, but in the meantime IAP monitoring may be considered in these new clinical contexts.…”

Section: Future Stepsmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps

2021

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Background and objective: Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. In this narrative review, we aim to provide a comprehensive overview of current insights into intra-abdominal pressure monitoring, intra-abdominal hypertension, and abdominal compartment syndrome. The focus of this review is on the pathophysiology, risk factors and outcome of intra-abdominal hypertension and abdominal compartment syndrome, and on therapeutic strategies, such as non-operative management, surgical decompression, and management of the open abdomen. Finally, future steps are discussed, including propositions of what a future guideline should focus on. Conclusions: Pathological intra-abdominal pressure is a continuum ranging from mild intra-abdominal pressure elevation without clinically significant adverse effects to substantial increase in intra-abdominal pressure with serious consequences to all organ systems. Intra-abdominal pressure monitoring should be performed in all patients at risk of intra-abdominal hypertension. Although continuous intra-abdominal pressure monitoring is feasible, this is currently not standard practice. There are a number of effective non-operative medical interventions that may be performed early in the patient’s course to reduce intra-abdominal pressure and decrease the need for surgical decompression. Abdominal decompression can be life-saving when abdominal compartment syndrome is refractory to non-operative treatment and should be performed expeditiously. The objectives of open abdomen management are to prevent fistula and to achieve delayed fascial closure at the earliest possible time. There is still a lot to learn and change. The 2013 World Society of Abdominal Compartment Syndrome guidelines should be updated and multicentre studies should evaluate the effect of intra-abdominal hypertension treatment on patient outcome.

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Intra-abdominal hypertension as a trigger of “gut failure” in SARS-CoV-2 infection: Effect of open abdomen (OA) and negative pressure therapy (NPT) on respiratory and gastrointestinal (GI) function

Cited by 7 publications

References 18 publications

Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review

Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

Intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients: A narrative review of past, present, and future steps

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