Health and Fitness

Study investigates intestinal ischemia in COVID-19 sufferers

In a latest article revealed within the journal Biomedicines, a crew of Italian scientists has introduced case studies of 5 coronavirus illness 2019 (COVID-19) sufferers present process emergency surgical procedure for intestinal ischemia.

Study: Intestinal Ischemia: Unusual however Fearsome Complication of COVID-19 Infection. Image Credit: Andrii Vodolazhskyi/Shutterstock

The case studies spotlight that the histopathological adjustments noticed within the gut of COVID-19 sufferers are much like that noticed within the lung, which is the first goal organ of extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2).


The gastrointestinal pathologies related to SARS-CoV-2 an infection are believed to be triggered by a number of elements. The presence of gastrointestinal signs has been noticed in about 40% of COVID-19 sufferers. Regarding mode of motion, research have advised that SARS-CoV-2 makes use of transmembrane serine protease TMPRSS2 to enter and replicate contained in the gastrointestinal (GI) tract. In addition, the virus may translocate from the respiratory tract to the GI tract by way of blood circulation.

However, there isn’t any clear proof whether or not intestinal damages are related to direct viral replication or SARS-CoV-2-induced hyper-coagulation.

In the present research, scientists have described case studies of 5 COVID-19 sufferers who had developed intestinal ischemia.

Important observations

The research included COVID-19 sufferers who have been present process surgical procedure for intestinal ischemia between March 2020 and May 2021 on the Emergency Surgery and Trauma Center Department of the University of Pisa, Italy.  

The first affected person was a 74-year-old man with a historical past of hypertension and ischemic coronary heart illness. Three days after COVID-19 prognosis, the affected person was intubated and shifted to the intensive care unit (ICU) due to creating dyspnea, extreme desaturation, vomiting, and coma. He additionally skilled acute belly distension. The findings of CT scan and laparotomy indicated ischemic intestinal alterations. The surgical removing of the cecum (part of the big gut) together with the terminal ileum (the final a part of the small gut) was carried out. The histological evaluation of surgically-removed ileum and cecum revealed ischemic necrosis of the mucosal layer and intestinal pneumatosis.    

The second affected person was a 69-year-old man with a historical past of hypertension and subdural hematoma. The CT scan and laparotomy findings indicated intestinal perforation. The surgical removing of the jejunum (the center a part of the small gut) and subsequent anastomosis was carried out. The histological evaluation revealed thickening of the intestinal wall, edema formation, and intestinal pneumatosis.

The third affected person was a 77-year-old man with a historical past of cardiovascular, pulmonary, and metabolic issues. The medical findings indicated ischemic intestinal perforation. The surgical removing of the one aspect of the colon together with ileostomy mucous fistula was carried out.

The fourth affected person was 75-year-old man with a historical past of myocardial infarction and gastric ulcer. The CT scan and laparotomy findings revealed intestinal perforation and interstitial pneumonia. Based on the medical findings, a resection anastomosis was carried out.    

The fifth affected person was a 72-year-old man with a historical past of hypertension, post-ischemic dilated coronary heart illness, atrial fibrillation, dyslipidemia, and power obstructive pulmonary illness. He was hospitalized as a result of COVID-19 associated interstitial pneumonia. The endoscopic and CT scan findings confirmed a clot and energetic arterial endoluminal bleeding within the duodenum. Despite administration of angioembolization (a medical process to scale back blood loss), the affected person repeatedly skilled energetic intestinal bleeding.

A collection of surgical procedures have been carried out to forestall the bleeding and restore the harm.   

During the post-surgical section, the affected person developed sepsis and peritonitis. On day 10 post-surgery, he died as a result of septic shock. The evaluation of surgically-removed intestinal samples confirmed dilated small intestinal wall and attenuated mucosa with fibrin stratification. In addition, ischemic necrosis and mucosal, muscular, and adipose tissue ulceration have been detected.   

The peritoneal fluid collected from the sufferers throughout surgical procedure was unfavourable for SARS-CoV-2. The immunohistochemical and molecular evaluation of patient-derived intestinal tissues confirmed weak depth expression of SARS-CoV-2-specific spike and nucleocapsid proteins in 4 out of 5 sufferers. A powerful expression of virus-specific proteins was noticed solely within the third affected person. Importantly, all sufferers confirmed infiltration of immune cells within the intestinal blood vessels and interstitial edema within the small gut and colon.  

Study significance

The research highlights that gastrointestinal manifestation in COVID-19 sufferers could or will not be related to respiratory or systemic signs. Although SARS-CoV-2 positivity within the intestinal tissue has been detected in just one affected person, endothelial irritation noticed within the intestinal vessels of all sufferers suggests a microvascular small intestinal damage. These medical options are much like that noticed within the small blood vessels of COVID-19-affected lungs.

Overall, the research findings point out that SARS-CoV-2 induces lung and intestinal harm by way of the same mode of motion. Given the research findings, the scientists counsel that physicians ought to rigorously monitor the presence of SARS-CoV-2 an infection within the gut of COVID-19 sufferers with the intention to keep away from extreme and deadly outcomes of ischemic intestinal perforation.

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