Severe colon ischemia in patients with severe COVID-2019 infection: a report of three cases

Abstract

Severe disease caused by the SARS-CoV coronavirus is characterized by patients presenting with respiratory distress associated with a systemic inflammatory response syndrome (cytokine storm). Sixteen to thirty percent of COVID-19 patients also have gastrointestinal symptoms. Here we present three cases of COVID-19 who developed colonic ischemia. Three males aged 76, 68 and 56 with respiratory distress and receiving mechanical ventilation presented episodes of rectal bleeding, abdominal distension and signs of peritoneal irritation. Endoscopy (case 1) and computed tomography angiography revealed colonic ischemia and pneumoperitoneum.One patient (case 2) underwent surgery in which perforation of the gangrenous cecum and colonic ischemia was confirmed.In all three patients D-dimer levels were markedly increased (2170, 2100 and 7360 ng/mL). All three patients died shortly after diagnosis.In severe COVID-19 disease, the pathogenic cause has increasingly become attributed to the development of disseminated intravascular coagulation secondary to the systemic inflammatory response.

Rectus Sheath Hematoma in COVID-19 Patients as a Mortal Complication: A Retrospective Report

“…Since the COVID-19 can intervene in intravascular systems, the majority of all deaths in patients with COVID-19 are attributed to VTE and disseminated intravascular coagulation (DIC) which are consequences of the systemic inflammatory response [ 26 , 27 ]. PTE is also associated with marked changes in some laboratory markers such as D-dimer and LDH according to recent radiologic surveys [ 28 , 29 ], that is why proper anticoagulant treatment to reduce PTE complications in COVID-19 patients is so crucial.…”

Acute Mesenteric Ischemia in a COVID-19 Patient: Delay in Referral and Recommendation for Surgery

“…Besides, Rashid et al [10], Faridi et al [11], Sevella et al [12], and Shahid et al [13] also confirmed these findings. Almeida et al also described three patients with intestinal ischemia and pneumoperitoneum and showed that the pathogenicity of COVID-19 has been increasingly attributed to the systemic inflammatory response leading to intravascular disseminated coagulation [14].…”