Acute Mesenteric Ischemia in COVID-19 Patients

Area of Science:

• Gastroenterology
• Infectious Diseases
• Vascular Surgery

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, causing COVID-19, is associated with thrombotic complications.
• Acute mesenteric ischemia, a rare but life-threatening condition, has been reported as a complication of COVID-19.

Purpose of the Study:

• To review and document clinical, laboratory, and imaging findings.
• To analyze management strategies and outcomes of acute intestinal ischemia in COVID-19 patients.
• To identify distinct features and risk factors associated with COVID-19-related bowel ischemia.

Main Methods:

• A systematic literature search was conducted on PubMed and Web of Science.
• Keywords included "COVID-19" and various forms of "bowel ischemia" or "mesenteric ischemia/thrombosis".
• Data from 36 articles on 89 patients were analyzed.

Main Results:

• Elevated D-dimers, leukocytosis, and C-reactive protein (CRP) were common. Contrast-enhanced CT confirmed vascular thromboembolism.
• Hospitalized patients predominantly showed large bowel ischemia (56%) with microvascular thrombosis, requiring surgery in 95.4%.
• Non-hospitalized patients had higher small bowel involvement (80%) and a 38.4% favorable response to anticoagulation. Mortality was significantly higher in hospitalized patients (54.4% vs. 21.7%).

Conclusions:

• COVID-19-related bowel ischemia presents differently in hospitalized versus non-hospitalized patients, suggesting varied pathophysiological mechanisms.
• Age over 60 and the need for surgery are associated with poorer outcomes.
• Understanding these mechanisms and risk factors is crucial for optimizing thromboprophylaxis and fluid management in COVID-19 patients.