1Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
2Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan.
Am J Trop Med Hyg. 2021 Mar 18;104(5):1655-1658. doi: 10.4269/ajtmh.20-1084.
The COVID-19 pandemic has caused serious health and social concerns worldwide. Although the primary target of SARS-CoV-2 is the respiratory tract, SARS-CoV-2 infection also causes extrapulmonary symptoms. Previous articles have reported ischemic colitis in COVID-19 patients; however, information regarding its clinical manifestations and pathophysiology is limited. In this case report, we present two cases of ischemic enterocolitis in COVID-19 patients and review past case reports. Our literature review has shown that computed tomography rather than endoscopy was used for the diagnosis, and any region of the intestine was affected. Because the elevation of the D-dimer, which suggested a hypercoagulable state, was reported in most cases, we assumed that thrombosis at any level in the artery and vein was involved in the pathophysiology of COVID-19-associated enterocolitis. SARS-CoV-2-induced endotheliitis can cause both coarctation of the vessels and thrombosis; therefore, both patterns of ischemic colitis, occlusive and nonocclusive, may be involved in COVID-19-associated enterocolitis.
新型冠状病毒肺炎（COVID-19）大流行在全球范围内引发了严重的健康和社会问题。尽管 SARS-CoV-2 的主要靶器官是呼吸道，但 SARS-CoV-2 感染也会引起肺外症状。先前的文章报道了 COVID-19 患者发生缺血性结肠炎，但关于其临床表现和病理生理学的信息有限。在本病例报告中，我们报告了 2 例 COVID-19 患者发生缺血性肠炎，并对既往病例报告进行了复习。我们的文献复习表明，诊断时使用的是计算机断层扫描（CT）而不是内镜，受累肠段可以是任何部位。由于大多数情况下 D-二聚体升高提示高凝状态，我们推测 COVID-19 相关肠炎的病理生理学涉及动脉和静脉的任何部位的血栓形成。SARS-CoV-2 诱导的血管内皮炎可导致血管狭窄和血栓形成；因此，COVID-19 相关肠炎可能涉及缺血性结肠炎的闭塞性和非闭塞性两种类型。
