Intestinal ischemia in COVID-19 patients: A case series

Abstract

Introduction: COVID-19 is associated with increased coagulability, resulting in thromboembolic complications, such as intestinal ischemia. Diagnosis of bowel infarction can be challenging due to the severity of illness and the laboratory changes associated with the COVID-19 infection itself. Case Series: In a retrospective monocentric study, we performed an in-depth analysis of the clinical course of intestinal ischemia in COVID-19 patients. Biochemical analysis of coagulation status and predictors of ischemia was performed. We identified five patients with intestinal ischemia, between March 2020 and January 2021. Mean time-to-onset of intestinal ischemia from COVID-diagnosis was 31 days (range 16–56). Intestinal ischemia was confirmed by contrast-enhanced computed tomography (CT) scan. D-dimer, Fibrinogen, C-reactive protein (CRP), and lactate dehydrogenase (LDH) were elevated prior to the ischemic event, but no recurrent pattern could be distinguished in our case series. Lactate levels demonstrated a marked increase at the time of ischemia in our series. No consistent findings were made for prothrombin time (PT) and activated partial thromboplastin time (aPTT) and creatin kinase. Extent of bowel ischemia varied between limited to the ileocecal region (two patients), additional ischemia of small and large bowel (two patients) and extensive ischemia of entire intestinal tract (one patient). Four patients (80%) required an ileostomy. Planned relook surgery was performed in three patients (60%). Three (60%) patients died. Conclusion: In the five days prior to an intestinal ischemic event in COVID-19 patients, we did not identify a clear pattern in commonly used markers for coagulation status and ischemia. However, lactate levels showed a recurrent pattern of clear increase leading up to the ischemic event and rapid normalization after surgery. Unfortunately, our patient numbers were too small to draw definitive conclusions.