Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute...

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.