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

作　　者：Lorenzo Norsa Pietro Andrea Bonaffini Maja Caldato Cristiana Bonifacio Aurelio Sonzogni Amedeo Indriolo Clarissa Valle Federica Furfaro Alice Bonanomi Paolo NiccolòFranco Mauro Gori Veronica Smania Lucia Scaramella Laura Forzenigo Maurizio Vecchi Monica Solbiati Giorgio Costantino Silvio Danese Lorenzo D'Antiga Sandro Sironi Luca Elli 

机构地区：[1]Department of Pediatric Gastroenterology Hepatology and Transplantation,ASST Papa Giovanni XXIII,Bergamo 24127,Italy [2]Department of Radiology Papa Giovanni XXIII Bergamo,University of Milano-Bicocca,Milan 20126,Italy [3]Fondazione IRCCS Ca’Granda,Department of Emergency Medicine,Ospedale Maggiore Policlinico,Milano 20122,Italy [4]Department of Radiology,Humanitas Clinical and Research Center,IRCCS,Rozzano 20089,Italy [5]Department of Pathology,ASST Papa Giovanni XXIII,Bergamo 24127,Italy [6]Department of Gastroenterology and Endoscopy,ASST Papa Giovanni XXIII,Bergamo 24127,Italy [7]IBD Center,Humanitas Clinical and Research Center IRCCS,Humanitas University,Rozzano 20089,Italy [8]Post-Graduate School of Diagnostic Radiology,University of Milano-Bicocca,Milano 20126,Italy [9]Cardiovascular Department,ASST Papa Giovanni XXIII,Bergamo 24127,Italy [10]Department of Gastroenterology and Endoscopy,Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico,Milano 20122,Italy [11]Department of Pathophysiology and Transplantation,University of Milan,Milano 20122,Italy [12]Department of Radiology,Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico,Milano 20122,Italy [13]Fondazione IRCCS Ca’Granda,Department of Emergency Medicine,Ospedale Maggiore Policlinico,Department of Clinical Sciences and Community Health,University of Milan,Milano 20122,Italy

出　　处：《World Journal of Gastroenterology》2021年第32期5448-5459,共12页世界胃肠病学杂志（英文版）

摘　　要：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.

关 键 词：CORONAVIRUS COVID-19 Ischemic colitis Small bowel ischemia Endothelial inflammation 

分 类 号：R563.1[医药卫生—呼吸系统] R574[医药卫生—内科学]