Liu Xin, Shi Xueying, Li Jun
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
Department of Pathology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Apr 18;56(2):362-365. doi: 10.19723/j.issn.1671-167X.2024.02.026.
Ischemic colitis is a disease in which local tissue in the intestinal wall dies to varying degrees due to insufficient blood supply to the colon. Risk factors include cardiovascular disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, . Typical clinical manifestations of the disease are abdominal pain and hematochezia. The most common locations are the watershed areas of splenic flexure and rectosigmoid junction. The lesions are segmental and clearly demarcated from normal mucosa under endoscopy. The digestive tract is a common extra-pulmonary organ affected by the novel coronavirus, which can be directly damaged by the virus or indirectly caused by virus-mediated inflammation and hypercoagulability. The corona virus disease 2019 (COVID-19) associated intestinal injury can be characterized by malabsorption, malnutrition, intestinal flora shift, . CT can show intestinal ischemia, intestinal wall thickening, intestinal wall cystoid gas, intestinal obstruction, ascites, intussusception and other signs. In this study, we reported a case of ischemic colitis in a moderate COVID-19 patient. The affected area was atypical and the endoscope showed diffuse lesions from the cecum to the rectosigmoid junction. No signs of intestinal ischemia were found on imaging and clear thrombosis in small interstitial vessels was found in pathological tissue. Combined with the fact that the patient had no special risk factors in his past history, the laboratory tests indicated elevated ferritin and D-dimer, while the autoantibodies and fecal etiology results were negative, we speculated that the hypercoagulability caused by novel coronavirus infection was involved in the occurrence and development of the disease in this patient. After prolonged infusion support and prophylactic anti-infection therapy, the patient slowly resumed diet and eventually went into remission. Finally, we hoped to attract clinical attention with the help of this case of moderate COVID-19 complicated with ischemic colitis which had a wide range of lesions and a slow reco-very. For patients with abdominal pain and blood in the stool after being diagnosed as COVID-19, even if they are not severe COVID-19, they should be alert to the possibility of ischemic colitis, so as not to be mistaken for gastrointestinal reactions related to COVID-19.
缺血性结肠炎是一种由于结肠血液供应不足导致肠壁局部组织不同程度坏死的疾病。危险因素包括心血管疾病、糖尿病、慢性肾脏病、慢性阻塞性肺疾病等。该病典型的临床表现为腹痛和便血。最常见的部位是脾曲和直肠乙状结肠交界处的分水岭区域。病变呈节段性，在内镜下与正常黏膜界限清晰。消化道是新型冠状病毒感染的常见肺外器官，可被病毒直接损伤或由病毒介导的炎症和高凝状态间接引起。2019冠状病毒病（COVID-19）相关的肠道损伤可表现为吸收不良、营养不良、肠道菌群失调等。CT可显示肠道缺血、肠壁增厚、肠壁囊样积气、肠梗阻、腹水、肠套叠等征象。在本研究中，我们报告了1例中度COVID-19患者发生缺血性结肠炎的病例。受累区域不典型，内镜显示从盲肠到直肠乙状结肠交界处弥漫性病变。影像学检查未发现肠道缺血征象，病理组织中发现小间质血管有明确血栓形成。结合患者既往无特殊危险因素，实验室检查提示铁蛋白和D-二聚体升高，自身抗体和粪便病原学结果均为阴性，我们推测新型冠状病毒感染引起的高凝状态参与了该患者疾病的发生发展。经过长时间的输液支持和预防性抗感染治疗，患者逐渐恢复饮食，最终病情缓解。最后，我们希望通过这例病变范围广、恢复缓慢的中度COVID-19合并缺血性结肠炎病例引起临床关注。对于确诊为COVID-19后出现腹痛和便血的患者，即使不是重症COVID-19，也应警惕缺血性结肠炎的可能，以免误诊为与COVID-19相关的胃肠道反应。
