Acute intestinal ischemia in patients with COVID-19: single-centre experience and literature review

OBJECTIVE: Acute Intestinal ischemia (AII) may involve the small and/or large bowel after any process affecting intes-tinal blood flow. COVID-19-related gastrointes-tinal manifestations, including AII, have been attributed to pharmacologic effects, metabolic disorders in ICU patients and other opportunis-tic colonic pathogens. AII in COVID-19 patients may be due also to "viral enteropathy" and SARS-CoV-2-induced small vessel thrombosis. A critical appraisal of personal experience re-garding COVID-19 and AII was carried out com-paring this with a systematic literature review of published series. PATIENTS AND METHODS: A retrospec-tive observational clinical cohort study and a systematic literature review including only COVID-19 positive patients with acute arterial or venous intestinal ischemia were performed. The primary endpoint of the study was the mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay. RESULTS: Patient mean age was 62.9 +/- 14.9, with a prevalence of male gender (23 male, 72% vs. 9 female, 28%). The mean Charlson Co-morbidity Index was 3.1 +/- 2.7. Surgery was per -formed in 24/32 patients (75.0%), with a mean delay time from admission to surgery of 6.0 +/- 5.6 days. Small bowel ischemia was confirmed to be the most common finding at surgical explora-tion (22/24, 91.7%). Acute abdomen at admission to the ED (Group 1) was observed in 10 (31.2%) cases, while 16 (50%) patients developed an acute abdomen condition during hospitalization (Group 2) for SARS-CoV-2 infection. CONCLUSIONS: Our literature review showed how intestinal ischemia in patients with SARS-CoV-2 has been reported all over the world. The majority of the patients have a high CCI with multiple comorbidities, above all hypertension and cardiovascular disease. GI symptoms were not always present at the admission. A high lev -el of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with incremental abdomi-nal pain. Nevertheless, a prompt thromboelasto-gram and laboratory test may confirm the need of improving and fastening the use of antico-agulants and trigger an extended indication for early abdominal CECT in patients with sugges-tive symptoms or biochemical markers of intes-tinal ischemia.