Pneumatosis Intestinalis in COVID-19

Lakshmanan, Seetha; Toubia, Nabil

doi:10.1016/j.cgh.2020.05.048

Cited by 15 publications

(11 citation statements)

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“…However, ischaemic colitis and pneumatosis intestinalis are not well reported in patients with active SARS-CoV-2 infection [7][8][9][10][11] nor MIS-C. One published case attributes the pneumatosis to direct mucosal damage 8 while another hypothesises the cause to be occlusive ischaemic colitis secondary to the hypercoagulopathy associated with COVID-19. 11 While we did not find mesenteric thrombosis on imaging, ischaemia leading to…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis and intestinal perforation in a case of multisystem inflammatory syndrome in children

2021

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This case demonstrates pneumatosis intestinalis and small bowel perforation in a paediatric patient with multisystem inflammatory syndrome in children (MIS-C). Our patient presented with fever, abdominal pain and shortness of breath. She progressed to haemodynamic failure and small bowel perforation approximately 1 week after admission. Patients with suspected or confirmed MIS-C should be monitored closely for abdominal catastrophe, especially when critically ill in the intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis and intestinal perforation in a case of multisystem inflammatory syndrome in children

2021

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“…Only four independent case reports have described PI in COVID-19 patients (35)(36)(37)(38). Importantly, although TCZ is being utilized as an experimental treatment for COVID-19, the two together may have adverse synergistic effects resulting in increased risk for PI and other related complications.…”

Section: Introductionmentioning

confidence: 99%

Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

et al. 2021

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This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia–reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.

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“…COVID-19 virus can cause PI by direct injury of mucosa of the gastrointestinal tract through its attachment to the angiotensinconverting enzyme receptors (ACER2), which are abundantly expressed on enterocytes [4] , or by disruption of the normal colonic gut flora or by bowel ischemia due to thromboembolic complications [5][6][7][8] .…”

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confidence: 99%

“…Herein, we summarize a few recent reports that have described the association of PI with COVID-19 ( Table 1 ) [5][6][7][8] . The mean age of the patients was 59 ± 16 years, all patients were males, one of them had no comorbidities, and two patients had abdominal pain.…”

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confidence: 99%

“…Although PI management is generally conservative, surgery is indicated in complicated cases of perforation, peritonitis, abdominal sepsis, and failed conservative management [10] . Lakshmanan and Toubia [5] Meini et al [6] Kietly et al [7] Aiello et al [8] Age, sex 72, male 44, male 47, male 73, male Medical history of comorbidities AF: atrial fibrillation, GIT: gastrointestinal tract, PI: pneumatosis intestinalis, CT: computed tomography, IVC: inferior vena cava, NA: not available.…”

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confidence: 99%

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