Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study

Figure 1 Computed tomography images from positive coronavirus disease 19 patients with abdominal signs and symptoms. A and B: The computed tomography (CT) scan revealed pneumoperitoneum (asterisks, A and B), dilated bowel loops with thin non-enhancing walls (orange arrows, B) and focal areas of pneumatosis in the descending colon (arrowhead, B), in keeping with intestinal ischemia. The main mesenteric vessels were patent (not shown); C: CT evidence of ischemic colitis involving the transverse and right portions of the colon: Markedly thickened and layered walls (thin arrow), compared to other normal appearing small and large bowel loops (curved arrow), with associated free fluid and oedematous stranding of the adjacent fat tissue (arrowheads); D and E: Axial CT scan shows multiple small bowel loops moderately dilated, with reduced thickness and poorly enhancing walls (orange arrows, D); concomitant diffuse oedema of the mesentery (orange arrowhead, D). In the same patient there were associated multiple peripheral splenic infarcts (withe arrows, E) with areas of mottled increased attenuation; the main splenic vessels were patent (not shown). Diffuse ascites (white arrowheads, E) is noted.

Figure 2 Endoscopic image of ischemic colitis. A: Oedematous mucosa with ischemic ulcerations; B: Presence of petechiae in an oedematous colic mucosa.

Figure 3 Histological features of ischemic damage of small and large bowel characterized by mucosal ulceration and fibrosis and vascular congestion of lamina propria associated with moderate mixed inflammatory infiltrate. A: Histological features of ischemic damage of small bowel; B: Histological features of ischemic damage of large bowel; C: Distinctive severe acute respiratory syndrome coronavirus 2 blood vessels inflammatory pattern with endothelial shrinkage and layering of granulocytes and lymphocytes on damaged vascular wall; D: Endothelial injury is emphasized by CD34 immunostaining of endothelial cells showing marked infiltration of inflammatory cells.

Figure 4 Survival curve of patients with intestinal ischemia.