Pietro Fransvea (Rome / IT), Paolo Mirco (Rome / IT), Gilda Pepe (Rome / IT), Antonio La Greca (Rome / IT), Sabina Magalini (Rome / IT), Caterina Puccioni (Rome / IT), Gaia Altieri (Rome / IT), Valerio Cozza (Rome / IT), Gabriele Sganga (Rome / IT), Silvia Tedesco (Rome / IT)
Abstract text (incl. references and figure legends)
Introduction: COVID-19-related gastrointestinal manifestations have been attributed to pharmacologic effects, metabolic disorders and other opportunistic colonic pathogens. AII in COVID-19 patients may be due also to "viral enteropathy" and SARS-CoV-2-induced small vessel thrombosis. Acute Intestinal ischemia may involve the small and/or large bowel after any process affecting intestinal blood flow. A critical appraisal of personal experience regarding COVID-19 and AII was carried out comparing this with a systematic literature review. Patients and methods: A retrospective 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 was the mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay. Results: a total of 32 patients were collected. Surgery was performed 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 exploration (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: Intestinal ischemia in patients with SARS-CoV-2 has been reported all over the world. The majority of the patients have a high CCI. GI symptoms were not always present at the admission. A high level of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with incremental abdominal pain. Nevertheless, we have to consider a prompt indication for early abdominal CECT in patients with suggestive symptoms or biochemical markers of intestinal ischemia.
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