Gastrointestinal Bleeding in Patients with SARS-CoV-2 Infection Managed by Interventional Radiology

Ierardi, Anna Maria; Coppola, Andrea; Tortora, Silvia; Valconi, Elena; Piacentino, Filippo; Fontana, Federico; Stellato, Elvira; Cogliati, Chiara; Torzillo, Daniela; Giampalma, Emanuela; Renzulli, Matteo; Bargellini, Irene; Cioni, Roberto; Scandiffio, Rossella; Spinazzola, A; Foà, Riccardo; Giudice, Costantino Del; Venturini, Massimo; Carrafiello, Gianpaolo

doi:10.3390/jcm10204758

Cited by 11 publications

(10 citation statements)

References 24 publications

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“…An element that could have hindered the rapid establishment of the diagnosis in this case was severe bleeding in a patient with a coagulopathy (a prolonged APTT and normal INR) and a history of major surgery without severe bleeding [ 34 ]. In our case, each bleeding episode was severe, resulting in severe anemia [ 35 ], but without hypovolemic shock, which contrasts with data obtained from other studies [ 36 , 37 ]. Coagulation tests, performed few days after admission, found a low level of FVIII, and a normal level of Factor IX.…”

Section: Discussioncontrasting

confidence: 99%

Esophageal ulcer associated with mild hemophilia A: case report

Nicolescu¹,

Neşiu²,

Uzum³

et al. 2022

Rom J Morphol Embryol

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In this paper, we present the case of a 68-year-old male with personal medical history of coagulopathy issues, who presented to our Emergency Room (Emergency County Hospital, Arad, Romania) with bleeding of the superior tract of the digestive system; the case was difficult to manage, thus warranting the intervention of the Department of Gastroenterology. Endoscopy was performed to localize the site of bleeding and to stop the hemorrhage. This procedure was not successful. The patient was transferred to our Intensive Care Unit where different medications, such as proton pump inhibitor, hemostatic agent and prokinetic drugs were administered. Unfortunately, our attempt to stop bleeding failed; this led us to expand our investigation. We focused on a possible hemophilia as the cause of bleeding, which was confirmed as hemophilia A through the coagulometry test after a period of three days. Patient medical history and coagulation test led us to believe that this is a very rare case of a mild hemophilia A. Finally, the correction of Factor VIII deficiency and repeated endoscopic hemostasis clip was able to stop patients bleeding and ensured a favorable clinical evolution of the patient.

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Section: Discussioncontrasting

confidence: 99%

Esophageal ulcer associated with mild hemophilia A: case report

Nicolescu¹,

Neşiu²,

Uzum³

et al. 2022

Rom J Morphol Embryol

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“…Several complications can arise during ICU stay, from both COVID-19 extensive lung damage and extra-pulmonary involvement, as well as those secondary to mechanical supporting systems [ 2 , 3 , 4 , 5 , 6 ]. Among these, bacterial and fungal co-infections and superinfections (or secondary infections) play an important role in COVID-19 disease and have been associated with increased morbidity and mortality, especially in critically ill patients [ 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

et al. 2022

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Background: Bacterial and fungal co-infections and superinfections have a critical role in the outcome of the COVID-19 patients admitted to the Intensive Care Unit (ICU). Methods: The present study is a retrospective analysis of 95 patients admitted to the ICU for COVID-19-related ARDS during the first (February–May 2020) and second waves of the pandemic (October 2020–January 2021). Demographic and clinical data, CT imaging features, and pulmonary and extra-pulmonary complications were recorded, as well as the temporal evolution of CT findings when more than one scan was available. The presence of co-infections and superinfections was registered, reporting the culprit pathogens and the specimen type for culture. A comparison between patients with and without bacterial and/or co-infections/superinfections was performed. Results: Sixty-three patients (66.3%) developed at least one confirmed co-infection/superinfection, with 52 (82.5%) developing pneumonia and 43 (68.3%) bloodstream infection. Gram-negative bacteria were the most common co-pathogens identified and Aspergillus spp. was the most frequent pulmonary microorganism. Consolidations, cavitations, and bronchiectasis were significantly associated with the presence of co-infections/superinfections (p = 0.009, p = 0.010 and p = 0.009, respectively); when considering only patients with pulmonary co-pathogens, only consolidations remained statistically significative (p = 0.004). Invasive pulmonary aspergillosis was significantly associated with the presence of cavitations and bronchiectasis (p < 0.001). Patients with co-infections/superinfections presented a significantly higher mortality rate compared to patients with COVID-19 only (52.4% vs. 25%, p = 0.016). Conclusions: Bacterial and fungal co-infections and superinfections are frequent in COVID-19 patients admitted to ICU and are associated with worse outcomes. Imaging plays an important role in monitoring critically ill COVID-19 patients and may help detect these complications, suggesting further laboratory investigations.

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“…Finally, as previously stated, in addition to systemic inflammation, liver dysfunction could be partially mediated by COVID-19-related coagulopathy and intrahepatic microvascular thrombosis [ 89 , 90 , 91 ]. This theory is also supported by laboratory findings, as demonstrated by a recent study that found an independent association between higher D-dimer levels and elevation of ALT [ 92 ].…”

Section: Hepatic Manifestations In Covid-19 Patientsmentioning

confidence: 85%

COVID-19: Has the Liver Been Spared?

Brandi

Spinelli

Granito

et al. 2023

IJMS

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The liver is a secondary and often collateral target of COVID-19 disease but can lead to important consequences. COVID-19 might directly cause a high number of complications in patients with pre-existing chronic liver disease, increasing their risk of hepatic decompensation. Moreover, it also determines indirect consequences in the management of patients with liver disease, especially in those suffering from decompensated cirrhosis and HCC, as well as in the execution of their follow-up and the availability of all therapeutic possibilities. Liver imaging in COVID-19 patients proved to be highly nonspecific, but it can still be useful for identifying the complications that derive from the infection. Moreover, the recent implementation of telemedicine constitutes a possible solution to both the physical distancing and the re-organizational difficulties arising from the pandemic. The present review aims to encompass the currently hypothesized pathophysiological mechanisms of liver injury in patients with COVID-19 mediated by both the direct invasion of the virus and its indirect effects and analyze the consequence of the pandemic in patients with chronic liver disease and liver tumors, with particular regard to the management strategies that have been implemented to face this worldwide emergency and that can be further improved.

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Gastrointestinal Bleeding in Patients with SARS-CoV-2 Infection Managed by Interventional Radiology

Cited by 11 publications

References 24 publications

Esophageal ulcer associated with mild hemophilia A: case report

Esophageal ulcer associated with mild hemophilia A: case report

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

COVID-19: Has the Liver Been Spared?

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