Spontaneous Rectal Perforation in a Patient with SARS–CoV-2 Infection

Giuffrè, Mauro; Bozzato, Alessandro Marco; Bella, Stefano Di; Occhipinti, Alessandro Agostino; Martingano, Paola; Cavallaro, Marco; Luzzati, Roberto; Monica, Fabio; Cova, Maria Assunta; Crocè, Lory Saveria

doi:10.3390/jpm10040157

Cited by 23 publications

(28 citation statements)

References 19 publications

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“…Where ACE2 receptor suggested to be the entry point for SARS-CoV-2 into the enterocytes explaining the gastrointestinal symptoms associated with the Disease. [13] A recently published multicounty metanalysis of a total of 4,243 COVID-19 patients, reported 17.6% prevalence of gastrointestinal symptoms. Anorexia was the most common symptom of 26.8% followed by diarrhea 12.5%, nausea/vomiting 10.2% and abdominal pain/discomfort of 9.2%.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Spontaneous Bowel Perforation

Alkatary¹,

Zarooni²,

Harthi³

2021

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The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients' demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Spontaneous Bowel Perforation

Alkatary¹,

Zarooni²,

Harthi³

2021

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“…For patients with COVID-19, a hypercoagulable state is a critical condition [ 25 , 68 , 69 ]. Studies have shown that in this disease, elevated D-dimer levels are correlated with the worst outcomes and the hypercoagulable state is associated with higher mortality [ 8 , 10 , 25 , 70 ]. Compared with survivors, non-survivors had significantly longer prothrombin time, higher fibrin degradation product and D-dimer levels, and activated partial thromboplastin time [ 3 , 71 ].…”

Section: Pathophysiology Of Endothelial Dysfunction In Covid-19 Infectionmentioning

confidence: 99%

“…Whereas most patients with COVID-19 show only mild symptoms, a proportion of patients develop severe complications within a short time after infection [ 2 , 4 , 5 ]. Both clinical studies and autopsy findings have shown evidence of vascular damage and thrombotic complications in multiple organs, such as acute ischemic or hemorrhagic stroke, myocardial injury, liver injury, acute kidney injury, as well as intestinal damage [ 6 , 7 , 8 , 9 , 10 , 11 ]. A number of studies have found that inflammatory processes, coagulation disorders, and microvascular thrombosis may exacerbate adult respiratory syndrome (ARDS) and extrapulmonary events in COVID-19 [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Endothelial Dysfunction and SARS-CoV-2 Infection: Association and Therapeutic Strategies

et al. 2021

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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), has been recently considered a systemic disorder leading to the procoagulant state. Preliminary studies have shown that SARS-CoV-2 can infect endothelial cells, and extensive evidence of inflammation and endothelial dysfunction has been found in advanced COVID-19. Endothelial cells play a critical role in many physiological processes, such as controlling blood fluidity, leukocyte activation, adhesion, platelet adhesion and aggregation, and transmigration. Therefore, it is reasonable to think that endothelial dysfunction leads to vascular dysfunction, immune thrombosis, and inflammation associated with COVID-19. This article summarizes the association of endothelial dysfunction and SARS-CoV-2 infection and its therapeutic strategies.

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“…Indeed, the activated EGCs massively release IL-6 and other inflammatory mediators, resulting in the so-called “cytokine storm” observed in COVID-19 patients. Therefore, in these cases, GI dysfunction may be considered as a possible marker of involvement of ENS/EGC, rather than an accessory symptom, highlighting a pathophysiological mechanism underlying SARS-CoV-2 neuroinvasion [ 194 , 195 , 196 , 197 ].…”

Section: Viral Influence On the Enteric Nervous Systemmentioning

confidence: 99%

You Talking to Me? Says the Enteric Nervous System (ENS) to the Microbe. How Intestinal Microbes Interact with the ENS

Giuffrè

Moretti

Campisciano

et al. 2020

JCM

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Mammalian organisms form intimate interfaces with commensal and pathogenic gut microorganisms. Increasing evidence suggests a close interaction between gut microorganisms and the enteric nervous system (ENS), as the first interface to the central nervous system. Each microorganism can exert a different effect on the ENS, including phenotypical neuronal changes or the induction of chemical transmitters that interact with ENS neurons. Some pathogenic bacteria take advantage of the ENS to create a more suitable environment for their growth or to promote the effects of their toxins. In addition, some commensal bacteria can affect the central nervous system (CNS) by locally interacting with the ENS. From the current knowledge emerges an interesting field that may shape future concepts on the pathogen–host synergic interaction. The aim of this narrative review is to report the current findings regarding the inter-relationships between bacteria, viruses, and parasites and the ENS.

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Spontaneous Rectal Perforation in a Patient with SARS–CoV-2 Infection

Cited by 23 publications

References 19 publications

COVID-19 Associated Spontaneous Bowel Perforation

COVID-19 Associated Spontaneous Bowel Perforation

Endothelial Dysfunction and SARS-CoV-2 Infection: Association and Therapeutic Strategies

You Talking to Me? Says the Enteric Nervous System (ENS) to the Microbe. How Intestinal Microbes Interact with the ENS

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