Department of General Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
Department of Digestive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
J Med Case Rep. 2022 Mar 25;16(1):135. doi: 10.1186/s13256-022-03276-z.
In addition to attacking the respiratory system, the coronavirus disease may attack the gastrointestinal tract in various ways, one of which is by creating a coagulopathy that may lead to acute ischemia of the bowel, increasing morbidity and mortality rates in these patients.
We present a case of a white 72-year-old European male, who was admitted to the intensive care unit after developing COVID-19-induced acute respiratory distress syndrome. On the third week, despite a favorable evolution of his respiratory symptoms, the patient became clinically septic; laboratory findings showed an augmentation of his D-dimer, fibrinogen, C-reactive protein, and procalcitonin levels. Imaging showed signs of ischemia of the right colon. The patient was taken to the operating room; only the right side of his colon was ischemic, with a well demarcated cut-off. A laparoscopic right hemicolectomy with a terminal ileostomy was performed. The patient was able to go home 2 weeks after surgery.
Ischemic colitis is an uncommon pathology in the general population, and is rare in COVID-19 patients. Most cases of ischemic colitis in COVID-19 patients in the literature were limited to the left colon, with < 10 cases involving the right colon. Accurate and quick diagnosis with appropriate management is the key to avoid any mortality in those patients who are already weakened by the coronavirus.
除了攻击呼吸系统外，冠状病毒疾病还可能通过多种方式攻击胃肠道，其中之一是通过产生凝血障碍，从而导致肠急性缺血，增加这些患者的发病率和死亡率。
我们介绍了一位 72 岁的白人欧洲男性患者，他因 COVID-19 引起的急性呼吸窘迫综合征而住进重症监护病房。在第三周，尽管他的呼吸症状有所好转，但患者仍出现临床脓毒症；实验室检查结果显示 D-二聚体、纤维蛋白原、C 反应蛋白和降钙素原水平升高。影像学显示右结肠缺血迹象。患者被送往手术室；只有他的右侧结肠缺血，有明确的截断。进行了腹腔镜右半结肠切除术和末端回肠造口术。患者在手术后 2 周能够回家。
缺血性结肠炎在普通人群中是一种罕见的病理学，在 COVID-19 患者中更为罕见。文献中 COVID-19 患者的缺血性结肠炎大多数局限于左结肠，<10 例涉及右结肠。准确快速的诊断和适当的治疗是避免那些已经因冠状病毒而虚弱的患者发生任何死亡的关键。
