Acute Mesenteric Ischemia in COVID-19 Patients

Abstract

Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

Diagnostic and prognostic value of the ratio of mean platelet volume to platelet count in acute mesenteric ischemia

“…Acute arterial obstruction of the small intestinal vessels and mesenteric ischemia may appear due to hypercoagulability associated with SARS-CoV-2 infection, mucosal ischemia, viral dissemination, and endothelial cell invasion vis ACE-2 receptors (24). Serban D et al (25) emphasized in their study that the diagnosis of an ischemic bowel should be one of the top differentials in critically ill patients with acute onset of abdominal pain and distension. So it is more than possible that we will encounter more patients with bowel ischemia than ever.…”

COVID-19-Associated Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia

“…Infection with SARS-CoV-2 occurs by aerosol droplet inhalation and is primarily characterized by respiratory symptoms. GI manifestations of COVID-19 such as nausea, vomiting, diarrhea, and abdominal pain have been well-documented; however, the true prevalence of GI symptoms among COVID-19 positive patients are unknown, ranging from less than 10% up to 70% in different reports [ 3 , 7 ]. While AMI is rare with an overall incidence less than 1%, AMI in the setting of COVID-19 warrants a high index of suspicion to avoid detrimental, possibly fatal, complications [ 8 ].…”

“…Although pulmonary presentations of the disease have predominated, extrapulmonary complications have also been reported in individuals with confirmed COVID-19 [ 1 , 2 ]. Acute mesenteric ischemia (AMI) is a less common thrombotic complication, being described in only a few case reports [ 3 ], but with high morbidity and mortality [ 1 , 2 , 4 ]. This report describes a patient affected by COVID-19 presenting as superior mesenteric artery (SMA) thrombosis and acute intestinal ischemia.…”

Non-Insulin Novel Antidiabetic Drugs Mechanisms in the Pathogenesis of COVID-19

“…Therefore, this enzyme is widely present in human organ tissues [ 6 , 7 ]. Nonetheless, the process of virus adhesion, the underlying receptors, and the mechanisms of triggering and perpetuating the immune response are highly complex [ 2 , 8 ].…”