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Cai W, Zhao Y, Mallappa S. Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia. Viruses 2024; 16:506. [PMID: 38675849 PMCID: PMC11054494 DOI: 10.3390/v16040506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES COVID-19 infection confers an increased risk of coagulation dysfunction (1) predisposing to thromboembolism in many anatomical sites including the gastrointestinal tract (GIT) (2). This study investigates the clinical presentation and outcome in patients presenting with concurrent COVID-19 infection and gastrointestinal tract ischaemia. Furthermore, differentiation and comparisons are drawn between those with arterial and venous aetiology for mesenteric ischaemia. METHODS A systematic search was undertaken on EMBASE, PubMed, and MEDLINE. Two independent reviewers screened titles, abstracts, and full-text articles according to the inclusion criteria and extracted relevant data. Data analyses were conducted using Excel®. RESULTS Forty-one studies were included in the data analyses, yielding 44 patients. Twenty-six patients had mesenteric arterial occlusion, sixteen patients had mesenteric venous occlusion, and two patients had both arterial and venous mesenteric occlusion. All patients had concurrent COVID-19 infection. The survival rate in patients with arterial aetiology was 38.5% in contrast to 68.8% in patients with venous aetiology. Twelve patients (29.3%) experienced respiratory symptoms in the community before the onset of gastrointestinal symptoms, and five (12.2%) developed gastrointestinal symptoms during their inpatient stay for COVID-19 pneumonitis. CONCLUSIONS Acute mesenteric ischaemia presents a clinical challenge to diagnose due to its non-specific symptoms. Concurrent COVID-19 infection with its predominant respiratory symptoms adds a further challenge in recognising the non-specific symptoms of mesenteric ischaemia. Our study draws attention to the increased thromboembolic risk posed by COVID-19 infection and the need for a high index of suspicion to aid prompt diagnosis and management of acute mesenteric ischaemia, even in the post-pandemic era.
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Affiliation(s)
- Wenyi Cai
- East Suffolk and North Essex Foundation Trust, Colchester CO4 5JL, UK
- Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK
| | - Yi Zhao
- Imperial College London School of Medicine, London SW7 2DD, UK;
| | - Sreelakshmi Mallappa
- West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire WD18 0HB, UK;
- The Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
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2
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Gries JJ, Sakamoto T, Chen B, Virk HUH, Alam M, Krittanawong C. Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review. J Clin Med 2024; 13:1217. [PMID: 38592672 PMCID: PMC10931623 DOI: 10.3390/jcm13051217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/02/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
Mesenteric ischemia is a challenging condition characterized by insufficient blood perfusion to the mesentery and, consequently, intestinal tissues that continues to perplex clinicians. Despite its low prevalence, the condition's variable clinical presentation and elusive radiographic diagnosis can delay life-saving interventions in the acute setting and deteriorate the quality of life of patients when left undiagnosed or misdiagnosed. PURPOSE Review and summarize recent diagnostic updates and emergent intervention strategies for acute and chronic mesenteric ischemia. METHODS A narrative review of all relevant studies from January 2022 through September 2023. RESULTS A total of 11 studies from MEDLINE, supplemented with 44 studies from Google Scholar, were included in the review. CONCLUSIONS Both acute and chronic mesenteric ischemia propose diagnostic and therapeutic challenges for interventionalists. Computed tomographic angiography remains the diagnostic modality of choice for both. Open surgical intervention remains the gold standard for acute mesenteric ischemia, while endovascular techniques are preferred for chronic mesenteric ischemia.
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Affiliation(s)
- Jacob J. Gries
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA;
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 1130033, Japan
- Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, Tokyo 1130033, Japan
| | - Bing Chen
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU School of Medicine, NYU Langone Health, New York, NY 10016, USA
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Gries JJ, Virk HUH, Chen B, Sakamoto T, Alam M, Krittanawong C. Advancements in Revascularization Strategies for Acute Mesenteric Ischemia: A Comprehensive Review. J Clin Med 2024; 13:570. [PMID: 38276076 PMCID: PMC10816895 DOI: 10.3390/jcm13020570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Even with modern advancements in the management of acute mesenteric ischemia over the past decade, morbidity and mortality remain high, and the best primary treatment modality is still debated amongst interventionalists. Traditionally, interventionalists have favored an open surgical approach but are now trending for endovascular interventions due to apparent reduced mortality and complications. Newer studies suggest hybrid approaches, and intestinal stroke centers may be superior to either strategy alone. This narrative review will explore the natural history of acute mesenteric ischemia with the aim of increasing interventionalist awareness of modern advancements in revascularization strategies for this devastating disease.
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Affiliation(s)
- Jacob J. Gries
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA;
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Bing Chen
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 113-0033, Japan
- Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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Burrows KR, Remington DL, Cappola JJ. Implications of COVID-19 in Acute Mesenteric Ischemia and Bowel Necrosis: A Case Report. Cureus 2023; 15:e47867. [PMID: 38021891 PMCID: PMC10680998 DOI: 10.7759/cureus.47867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to provoke a state of hypercoagulability that may lead to devastating consequences. This has been well established since the onset of the coronavirus pandemic in 2019; however, the specific relationship between COVID-19 and thrombus formation remains poorly understood. There has been increasing documentation of gastrointestinal (GI) complications in patients infected with the virus, including potentially lethal acute mesenteric ischemia (AMI), regardless of prior history of GI disease or risk factors for hypercoagulable states. Not only is mesenteric ischemia difficult to diagnose but it is also associated with high rates of morbidity and mortality, warranting prompt identification and treatment to improve clinical outcomes. We herein present a case of diffuse intestinal necrosis secondary to mesenteric thrombus formation in a previously healthy female five days after the resolution of her COVID-19 symptoms. The high rates of morbidity and mortality linked to AMI underpin the need for clinicians to maintain a high index of suspicion for thrombotic complications of COVID, even in healthy patients. This case emphasizes the importance of a thorough history-taking, physical examination, and laboratory workup even in patients without a current COVID-19 infection or predisposing thrombotic risk factors. Additionally, it suggests that the hypercoagulable state associated with a COVID-19 infection may persist after the primary COVID-19 symptoms have resolved.
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Affiliation(s)
- Kelsey R Burrows
- General Surgery, Campbell University School of Osteopathic Medicine, Lillington, USA
| | - David L Remington
- General Surgery, University of North Carolina (UNC) Wayne, Goldsboro, USA
| | - James J Cappola
- Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
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Brogna B, Bignardi E, Megliola A, Laporta A, La Rocca A, Volpe M, Musto LA. A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications. Biomedicines 2023; 11:2113. [PMID: 37626610 PMCID: PMC10452395 DOI: 10.3390/biomedicines11082113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
With the Omicron wave, SARS-CoV-2 infections improved, with less lung involvement and few cases of severe manifestations. In this pictorial review, there is a summary of the pathogenesis with particular focus on the interaction of the immune system and gut and lung axis in both pulmonary and extrapulmonary manifestations of COVID-19 and the computed tomography (CT) imaging features of COVID-19 pneumonia from the beginning of the pandemic, describing the typical features of COVID-19 pneumonia following the Delta variant and the atypical features appearing during the Omicron wave. There is also an outline of the typical features of COVID-19 pneumonia in cases of breakthrough infection, including secondary lung complications such as acute respiratory distress disease (ARDS), pneumomediastinum, pneumothorax, and lung pulmonary thromboembolism, which were more frequent during the first waves of the pandemic. Finally, there is a description of vascular extrapulmonary complications, including both ischemic and hemorrhagic abdominal complications.
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Affiliation(s)
- Barbara Brogna
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Elio Bignardi
- Department of Radiology, Francesco Ferrari Hospital, ASL Lecce, 73042 Casarano, Italy;
| | - Antonia Megliola
- Radiology Unit, “Frangipane” Hospital, ASL Avellino, 83031 Ariano Irpino, Italy; (A.M.); (M.V.)
| | - Antonietta Laporta
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Andrea La Rocca
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
| | - Mena Volpe
- Radiology Unit, “Frangipane” Hospital, ASL Avellino, 83031 Ariano Irpino, Italy; (A.M.); (M.V.)
| | - Lanfranco Aquilino Musto
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (A.L.); (A.L.R.); (L.A.M.)
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Kanugula AK, Kumar V, Gorle S, Maddika SR, Kaur J, Gaduputi V, Gayam V. Outcomes of Acute Mesenteric Ischemia in Patients With COVID-19: A Nationwide Database Study. Cureus 2023; 15:e41444. [PMID: 37426399 PMCID: PMC10324428 DOI: 10.7759/cureus.41444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Initially regarded as primarily a respiratory illness, coronavirus disease 2019 (COVID-19) has since been recognized as a complex disease affecting multiple systems. A COVID-19 infection can cause a hypercoagulable state leading to thrombotic complications in various systems. Acute mesenteric ischemia (AMI) has been reported as a rare complication of COVID-19, carrying a significant mortality rate. Although some risk factors for AMI in COVID-19 patients have been identified, there is a lack of large-scale studies examining outcomes and predictors of mortality. This study aims to assess the outcomes and identify predictors of mortality in a larger cohort of hospitalized COVID-19 patients with AMI, utilizing a retrospective analysis of the National Inpatient Sample (NIS) database. Methods Data from the 2020 NIS database were retrospectively analyzed. Patients aged 18 years and older, with a principal diagnosis of mesenteric ischemia were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes. The population was divided into mesenteric ischemia with COVID-19 and mesenteric ischemia without COVID-19. Patient demographics, comorbidities, hospital characteristics, and outcomes such as mortality, length of stay, and costs were analyzed. Multivariable logistic regression was performed to identify predictors of mortality. Results Among the 18,185 patients with acute mesenteric ischemia in 2020, 2.1% (n=370) had AMI with COVID-19 while 97.9% (n=17,810) had AMI only. In comparison to those without COVID-19, patients with AMI and COVID-19 had significantly higher in-hospital mortality. They also had higher odds of acute kidney injury, coronary artery disease, and ICU admission. Increasing age and white race were identified as predictors of mortality. Patients with COVID-19 had longer hospital stays and higher total costs compared to those without COVID-19. Discussion In this retrospective analysis of the NIS database, COVID-19 infection was associated with higher mortality in patients with AMI. Additionally, COVID-19 patients with AMI experienced increased odds of complications and higher resource utilization. Advanced age and white race were identified as predictors of mortality. These findings emphasize the importance of early recognition and management of AMI in COVID-19 patients, especially in high-risk populations.
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Affiliation(s)
| | - Vikash Kumar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
- Internal Medicine, The Brooklyn Hospital Center, New York, USA
| | - Swathi Gorle
- Internal Medicine, Wellstar Spalding Regional Medical Center, Griffin, USA
| | - Srikanth R Maddika
- Internal Medicine, Wellstar Spalding Regional Medical Center, Griffin, USA
| | - Jasleen Kaur
- Endocrinology, Diabetes and Metabolism, HealthPartners, Minneapolis, USA
| | - Vinaya Gaduputi
- Gastroenterology and Hepatology, Blanchard Valley Health System, Findlay, USA
| | - Vijay Gayam
- Gastroenterology and Hepatology, The Brooklyn Hospital Center, New York, USA
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Silva JTC, Fonseca Neto OCLDA. Acute mesenteric ischemia and COVID-19: an integrative review of the literature. Rev Col Bras Cir 2023; 50:e20233334. [PMID: 36921130 PMCID: PMC10519703 DOI: 10.1590/0100-6991e-20233334-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/24/2022] [Indexed: 03/18/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.
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Gastrointestinal perforation and vascular thrombosis in patients with corona virus disease-19: A life-threatening problem. Indian J Gastroenterol 2022; 41:218-223. [PMID: 35767212 PMCID: PMC9244307 DOI: 10.1007/s12664-022-01265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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