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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute
Wenyi Cai1,2, Yi Zhao3, Sreelakshmi Mallappa4,5
1East Suffolk and North Essex Foundation Trust, Colchester CO4 5JL, UK.
Insights
COVID-19 infection increases the risk of gastrointestinal tract ischemia, particularly mesenteric ischemia. Patients with venous mesenteric ischemia had a higher survival rate than those with arterial mesenteric ischemia.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Vascular Surgery
Background:
- COVID-19 infection is associated with an increased risk of thromboembolism, affecting various anatomical sites including the gastrointestinal tract.
- Coagulation dysfunction is a known complication of COVID-19, predisposing patients to thrombotic events.
- Gastrointestinal tract ischemia (mesenteric ischemia) presents diagnostic challenges due to non-specific symptoms, further complicated by concurrent COVID-19 infection.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of patients with concurrent COVID-19 infection and gastrointestinal tract ischemia.
- To differentiate and compare outcomes between patients with arterial versus venous mesenteric ischemia.
- To highlight the increased thromboembolic risk associated with COVID-19 and its implications for diagnosing mesenteric ischemia.
Main Methods:
- A systematic literature search was conducted across EMBASE, PubMed, and MEDLINE databases.
- Two independent reviewers screened titles, abstracts, and full-text articles based on predefined inclusion criteria.
- Data extraction and analysis were performed using Excel®, focusing on patient demographics, etiology of ischemia, and outcomes.
Main Results:
- The study analyzed data from 44 patients across 41 studies, all with concurrent COVID-19 infection.
- Mesenteric arterial occlusion occurred in 26 patients, mesenteric venous occlusion in 16, and both in 2.
- Survival rates were 38.5% for arterial mesenteric ischemia versus 68.8% for venous mesenteric ischemia.
Conclusions:
- Concurrent COVID-19 infection complicates the diagnosis of acute mesenteric ischemia due to overlapping symptoms.
- A high index of suspicion is crucial for the prompt diagnosis and management of acute mesenteric ischemia in patients with or recovering from COVID-19.
- The findings underscore the persistent need to consider COVID-19-related thromboembolic risk, even in the post-pandemic era, for gastrointestinal emergencies.
Objectives:
COVID-19 infection confers an increased risk of coagulation dysfunction (1) predisposing to thromboembolism in many anatomical sites including the gastrointestinal tract (GIT) (2). This study investigates the clinical presentation and outcome in patients presenting with concurrent COVID-19 infection and gastrointestinal tract ischaemia. Furthermore, differentiation and comparisons are drawn between those with arterial and venous aetiology for mesenteric ischaemia.
Methods:
A systematic search was undertaken on EMBASE, PubMed, and MEDLINE. Two independent reviewers screened titles, abstracts, and full-text articles according to the inclusion criteria and extracted relevant data. Data analyses were conducted using Excel®.
Results:
Forty-one studies were included in the data analyses, yielding 44 patients. Twenty-six patients had mesenteric arterial occlusion, sixteen patients had mesenteric venous occlusion, and two patients had both arterial and venous mesenteric occlusion. All patients had concurrent COVID-19 infection. The survival rate in patients with arterial aetiology was 38.5% in contrast to 68.8% in patients with venous aetiology. Twelve patients (29.3%) experienced respiratory symptoms in the community before the onset of gastrointestinal symptoms, and five (12.2%) developed gastrointestinal symptoms during their inpatient stay for COVID-19 pneumonitis.
Conclusions:
Acute mesenteric ischaemia presents a clinical challenge to diagnose due to its non-specific symptoms. Concurrent COVID-19 infection with its predominant respiratory symptoms adds a further challenge in recognising the non-specific symptoms of mesenteric ischaemia. Our study draws attention to the increased thromboembolic risk posed by COVID-19 infection and the need for a high index of suspicion to aid prompt diagnosis and management of acute mesenteric ischaemia, even in the post-pandemic era.
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