Ischemic Colitis in a Patient with Severe COVID-19 Pneumonia

Krejčová, Ilona; Berková, Alena; Kvasnicová, Laura; Vlček, Petr; Veverková, Lenka; Penka, Igor; Zoufalý, Dušan; Červeňák, Vladimír

doi:10.1159/000525840

Cited by 9 publications

(24 citation statements)

References 38 publications

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“…GI disorders due to ischaemia occur more frequently in the lower GI tract, which has a poorer blood supply than the upper GI tract wherein ischaemic changes less frequently occur 21. Patients with COVID-19 have been reported to develop ischaemic GI disorders previously 22–27. In the cohort with GI bleeding due to pneumonia other than COVID-19, the rate of GI bleeding due to ischaemic changes was not high.…”

Section: Discussionmentioning

confidence: 95%

COVID-19 severity is associated with the risk of gastrointestinal bleeding

Hibiya,

Fujii,

Fujii

et al. 2023

BMJ Open Gastroenterol

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ObjectiveThe association between the severity of COVID-19 and gastrointestinal (GI) bleeding is unknown. This study aimed to determine whether the severity of COVID-19 is a risk factor for GI bleeding.DesignA multicentre, retrospective cohort study was conducted on hospitalised patients with COVID-19 between January 2020 and December 2021. The severity of COVID-19 was classified according to the National Institute of Health severity classification. The primary outcome was the occurrence of GI bleeding during hospitalisation. The main analysis compared the relationship between the severity of COVID-19 and the occurrence of GI bleeding. Multivariable logistic regression analysis was performed to evaluate the association between the severity of COVID-19 and the occurrence of GI bleeding.Results12 044 patients were included. 4165 (34.6%) and 1257 (10.4%) patients had severe and critical COVID-19, respectively, and 55 (0.5%) experienced GI bleeding. Multivariable analysis showed that patients with severe COVID-19 had a significantly higher risk of GI bleeding than patients with non-severe COVID-19 (OR: 3.013, 95% CI: 1.222 to 7.427). Patients with critical COVID-19 also had a significantly higher risk of GI bleeding (OR: 15.632, 95% CI: 6.581 to 37.130). Patients with severe COVID-19 had a significantly increased risk of lower GI bleeding (OR: 10.349, 95% CI: 1.253 to 85.463), but the risk of upper GI bleeding was unchanged (OR: 1.875, 95% CI: 0.658 to 5.342).ConclusionThe severity of COVID-19 is associated with GI bleeding, and especially lower GI bleeding was associated with the severity of COVID-19. Patients with severe or critical COVID-19 should be treated with caution as they are at higher risk for GI bleeding.

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Section: Discussionmentioning

confidence: 95%

COVID-19 severity is associated with the risk of gastrointestinal bleeding

Hibiya,

Fujii,

Fujii

et al. 2023

BMJ Open Gastroenterol

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“… 10 Ischemic colitis in COVID-19 patients is associated with hypercoagulation. 11 The etiology of GI bleeding in COVID-19-infected patients is multifactorial, and identifying potential risk factors and predictive tools is essential. In our cohort, 72.2% of patients were on chronic antiplatelet therapy or anticoagulation, and 94.4% were started on anticoagulation using low molecular weight heparin (LMWH) per local COVID-19 infection therapy protocol.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes

Al Hanaei,

AlKindi,

Alkhemeiri

et al. 2024

IJGM

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Introduction Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients. Methods Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size. Results Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3–54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection. Conclusion The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.

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“…Limited cases of APS-associated severe ischaemic colitis are reported, most in association with diagnosis of catastrophic APS [ 3 , 12–14 ]. Other reported cases of hypercoagulability and microvascular thrombosis resulting in fulminant ischaemic colitis include that of coronavirus disease 2019 infection [ 7–9 ] and inherited Factor V Leiden mutation [ 10 ]. In all cases of venous and microvenular ischaemic colitis onset was slow, with a wide variation of primary symptoms and CT imaging findings.…”

Section: Discussionmentioning

confidence: 99%

Severe ischaemic colitis secondary to microvenular thrombosis in a hypercoagulable patient

Moran,

Trivedi

2024

Journal of Surgical Case Reports

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A young patient with multifactorial prothrombotic risk factors presented with signs and symptoms of ischaemic colitis, without evidence of bowel hypoperfusion on imaging. She deteriorated with trial of conservative management and required operative management. Intraoperative findings demonstrated severe, confluent large bowel necrosis, sparing the rectum. A total colectomy was performed, with return to intensive care unit due to intraoperative hemodynamic instability. A return to theatre the following day allowed for formation of ileostomy and definitive closure. Histopathological findings of microvenular thrombosis were confirmed. Venous causes of ischaemic colitis present diagnostic challenges due to variable presentation and imaging findings. Microvascular venous thrombosis is likely secondary to multifactorial prothrombotic risk factors including positive autoantibodies and variable compliance with warfarin therapy for aortic value replacement. We present this case of ischemic colitis secondary to an unusual aetiology to emphasize the need to remain clinically suspicious of severe abdominal pain despite relatively benign imaging findings.

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Ischemic Colitis in a Patient with Severe COVID-19 Pneumonia

Cited by 9 publications

References 38 publications

COVID-19 severity is associated with the risk of gastrointestinal bleeding

COVID-19 severity is associated with the risk of gastrointestinal bleeding

Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes

Severe ischaemic colitis secondary to microvenular thrombosis in a hypercoagulable patient

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