Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2021; 27(32): 5448-5459
Published online Aug 28, 2021. doi: 10.3748/wjg.v27.i32.5448
Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study
Lorenzo Norsa, Pietro Andrea Bonaffini, Maja Caldato, Cristiana Bonifacio, Aurelio Sonzogni, Amedeo Indriolo, Clarissa Valle, Federica Furfaro, Alice Bonanomi, Paolo Niccolò Franco, Mauro Gori, Veronica Smania, Lucia Scaramella, Laura Forzenigo, Maurizio Vecchi, Monica Solbiati, Giorgio Costantino, Silvio Danese, Lorenzo D'Antiga, Sandro Sironi, Luca Elli
Lorenzo Norsa, Lorenzo D'Antiga, Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
Pietro Andrea Bonaffini, Clarissa Valle, Sandro Sironi, Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
Maja Caldato, Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Milano 20122, Italy
Cristiana Bonifacio, Department of Radiology, Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Italy
Aurelio Sonzogni, Department of Pathology, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
Amedeo Indriolo, Department of Gastroenterology and Endoscopy, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
Federica Furfaro, Silvio Danese, IBD Center, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano 20089, Italy
Alice Bonanomi, Paolo Niccolò Franco, Sandro Sironi, Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
Mauro Gori, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
Veronica Smania, Lucia Scaramella, Maurizio Vecchi, Luca Elli, Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
Veronica Smania, Lucia Scaramella, Maurizio Vecchi, Luca Elli, Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
Laura Forzenigo, Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
Monica Solbiati, Giorgio Costantino, Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milano 20122, Italy
Author contributions: Caldato M, Bonifacio C, Valle C, Furfaro F, Gori M, Smania V and Scaramella L did data acquisition; Norsa L, Bonaffini PA, Sonzogni A and Indriolo A drafted the manuscript; Norsa L, Bonanomi A and Franco PN did the figures selection and production; Forzenigo L, Vecchi M, Solbiati M, Costantino G, Danese S, D’Antiga L, Sironi S and Elli L critically reviewed the paper.
Institutional review board statement: The study was reviewed and approved by the ASST Papa Giovanni XXIII Institutional Review Board, No. 2020-0096.
Informed consent statement: Informed consent from patients was waived because of the retrospective nature of the study.
Conflict-of-interest statement: The authors declare no conflict of interest and no financial support for this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at lnorsa@asst-pg23.it.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lorenzo Norsa, PhD, Doctor, Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy. lnorsa@asst-pg23.it
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: April 29, 2021
Revised: April 30, 2021
Accepted: July 23, 2021
Article in press: July 23, 2021
Published online: August 28, 2021
Processing time: 151 Days and 19.4 Hours
Abstract
BACKGROUND

Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19).

AIM

To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection.

METHODS

A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1st and May 30th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed.

RESULTS

Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%.

CONCLUSION

Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.

Keywords: Coronavirus; COVID-19; Ischemic colitis; Small bowel ischemia; Endothelial inflammation

Core Tip: Ischemic manifestations have been described as possible presenting symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These manifestations are frequent in the respiratory tract and bear a high fatality rate. Our retrospective observational trial aims to describe the prevalence, the characteristics and the evolution of patients presenting with intestinal ischemic manifestations of SARS-CoV-2 infection.