Case Report: Ischemic Enterocolitis Associated with Coronavirus Disease 2019: Two Case Reports and a Review of the Literature

Abstract

The COVID-19 pandemic has caused serious health and social concerns worldwide. Although the primary target of SARS-CoV-2 is the respiratory tract, SARS-CoV-2 infection also causes extrapulmonary symptoms. Previous articles have reported ischemic colitis in COVID-19 patients; however, information regarding its clinical manifestations and pathophysiology is limited. In this case report, we present two cases of ischemic enterocolitis in COVID-19 patients and review past case reports. Our literature review has shown that computed tomography rather than endoscopy was used for the diagnosis, and any region of the intestine was affected. Because the elevation of the D-dimer, which suggested a hypercoagulable state, was reported in most cases, we assumed that thrombosis at any level in the artery and vein was involved in the pathophysiology of COVID-19–associated enterocolitis. SARS-CoV-2–induced endotheliitis can cause both coarctation of the vessels and thrombosis; therefore, both patterns of ischemic colitis, occlusive and nonocclusive, may be involved in COVID-19–associated enterocolitis.

Acute right-sided ischemic colitis in a COVID-19 patient: a case report and review of the literature

“…From the limited cases of GI ischemia in COVID-19 patients in the literature, almost half of patients died, even after surgical intervention [ 4 – 10 ]. This shows the extent of severity of this virus when attacking the GI system.…”

“…Infection by SARS-CoV-2 in severe cases can trigger a rapid and intense innate immune response (the cytokine storm) that leads to the release of proinflammatory and procoagulant cytokines (interleukins, tumor necrosis factor-alpha, interferons) [ 5 ], making those patients more susceptible to tissue damage and necrosis. Since the start of this pandemic, few cases of COVID-19-induced ischemic colitis have been reported in the literature [ 4 – 10 ]. We report an uncommon case of a 72-year-old male COVID-19 patient, who developed a well-limited and demarcated ischemic colitis of the right colon with a favorable recovery during hospitalization.…”

COVID-19-Associated Ischemic Colitis: A Rare Manifestation of COVID-19 Infection—Case Report and Review

“…We searched the medical literature for reports of COVID-19-associated ischemic colitis and identified 15 patients from 9 publications with COVID-19-associated ischemic colitis and their characteristics are summarized in Table 1 . 13 - 21 Among the 15 patients, the outcome of 1 patient was not reported, 13 8 patients died, and 6 patients survived the illness. Among the survivors, 2 patients were managed medically 19 , 20 and 4 patients required surgical management.…”

“… 13 - 21 Among the 15 patients, the outcome of 1 patient was not reported, 13 8 patients died, and 6 patients survived the illness. Among the survivors, 2 patients were managed medically 19 , 20 and 4 patients required surgical management. We excluded 4 patients with ischemic enteritis, 16 , 20 , 22 2 patients with incidentally found pneumatosis intestinalis, 23 , 24 and cross-sectional studies published by Vanella et al and Bhayana et al on mucosal damage (6 patients with left-sided and 3 patients with diffuse ischemic colitis) and abdominal imaging findings in COVID-19 patients, respectively, due to limited availability of patient information (age, sex, preexisting condition[s], GI symptom[s], vasopressor requirement, presence of intravascular thrombus, treatment, and outcomes).…”