Bowel perforation in morbid obesity secondary to COVID-19 infection

Jacob, Allen; Puskoor, Sujith; White, Heath

doi:10.1080/08998280.2021.2003099

Cited by 1 publication

(3 citation statements)

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“…The high enterocytic concentration of the ACE2 receptor, the receptor through which SARS-CoV-2 invades the cells, could predispose the intestinal tract to direct viral invasion and damage ( 3 ). Similar to a case report by Jacob et al ( 11 ), two of our patients did not have any vascular abnormality on histopathologic examinations. We hypothesize that direct viral invasion of the intestinal wall through enterocytic ACE2 receptors could have caused intestinal ischemia in the two mentioned cases.…”

Section: Discussionsupporting

confidence: 91%

“…Compared to the patients without intestinal ischemia from the same hospital ( 1 ), CRP was significantly higher among the patients in the present study. Increased CRP is also reported in the previous studies ( 5 , 11 , 26 ) and is known as a marker of poor prognosis among COVID-19 patients ( 27 , 28 ). Similar to the previous studies ( 7 , 8 ), D-dimer was also significantly increased among our patients, surpassing 5,000 ng/mL in some patients.…”

Section: Discussionsupporting

confidence: 73%

“…The symptoms and signs of intestinal ischemia were initiated 7 days following the respiratory manifestations of COVID-19. The precedence of respiratory manifestations has also been mentioned in the previous studies ( 6 , 7 , 10 , 11 , 26 ). However, some studies report the concomitant PCR confirmation of COVID-19 and intestinal ischemia ( 7 , 8 , 12 ).…”

Section: Discussionsupporting

confidence: 69%

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COVID-19 and Intestinal Ischemia: A Multicenter Case Series

et al. 2022

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IntroductionGastrointestinal symptoms are common among COVID-19 patients. Although gastrointestinal involvements are mostly benign, they rarely indicate a severe pathology like intestinal ischemia. The present case series describes 21 patients with bowel ischemia, necrosis, or perforation.MethodsThe present case series was conducted from April 2020 to February 2022 in the surgical wards of two Iranian hospitals. We retrospectively included adult patients with concomitant COVID-19 and intestinal ischemia. Primary outcomes were defined as the length of stay and survival.ResultsTwenty-four patients with a median age of 61.5 years were included in the study. Sixteen (67%) patients were male, and 13 (54%) were without any comorbidities. Macrovascular mesenteric ischemia was not identified in 21 patients (87.5%). Gastrointestinal manifestations appeared on the median of seven days (range 2–21) after the diagnosis of COVID-19, with the most common symptom being abdominal pain. All the patients had a significantly elevated C-Reactive Protein prior to surgery, ranging from 68 to 362. D-dimer was measured in eight patients and was significantly elevated, ranging from 1,878 to over 5,000 ng/mL. One patient was managed conservatively due to a good clinical condition. Except for one patient with angioinvasive mucormycosis and one other with leukocytoclastic vasculitis, pathologic evaluation revealed general features of intestinal necrosis, including ulcer, hemorrhage, necrosis, neutrophilic infiltration (in seven patients), neutrophilic abscess (in four patients), and edema. Bowel necrosis accompanied mortality of 15 (62.5%) patients and a median of 6.5 days of hospital stay.ConclusionIntestinal ischemia in COVID-19 patients is associated with a high mortality rate. Further research is needed to elucidate the dynamics of intestinal ischemia in the setting of COVID-19.

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Section: Discussionsupporting

confidence: 91%