Intestinal Infarction in COVID-19 Pandemic: A Case Series

Effects of the COVID-19 pandemic on trauma-related emergency medical service in older people: a retrospective cohort study

INTRODUCTION

The ever-increasing human life expectancy has currently resulted in a noticeable rise in the world's older population. Addressing the healthcare needs of the older people has become a significant concern for many countries. Moreover, the older people are particularly vulnerable to traumatic events. This study aimed to examine the impact of the COVID-19 pandemic on prehospital care provided by Emergency Medical Services (EMS) for trauma-related cases among the older people in Iran.

METHODS

This retrospective cohort study involved analyzing the medical records of 1,111 older people aged above 60 who experienced traumatic injuries and received pre-hospital emergency services from March 2018 to March 2022. In order to collect the data, the checklist made by the researcher was used and data analysis in SPSS16 was done using the Chi-square test and Fisher's exact test.

RESULTS

The age group of 60-74 received the highest number of services both before and after the COVID-19 pandemic. The older men experienced more traumatic events compared to women throughout the study period. The majority of the traumatic events occurred between 8 a.m. and 12 p.m. both before and after the COVID-19 pandemic.

CONCLUSIONS

The high prevalence rate of geriatric traumas can be primarily attributed to their physical problems and no control over movements caused by old age, as well as unsafe living conditions. To address these issues, it is suggested that facilities be provided to assist with mobility problems. Moreover, constructing suitable pedestrian bridges and regularly checking neighborhoods and surroundings to identify potential risk factors should be prioritized. Once these risk factors are identified, efforts can be made to adjust and eliminate them, thereby minimizing traumatic events and enhancing a safe and friendly environment for the older people.

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

Although the novel severe acute respiratory syndrome coronavirus-2 is known primarily to affect the respiratory system, current evidence supports its capability to infect and induce gastrointestinal tract injury. Data describing the histopathologic alterations of the digestive system in patients infected with severe acute respiratory syndrome coronavirus-2 are becoming more detailed, as the number of studies is increasing and the quality of our insight into the infection and the histopathologic findings is improving. This review highlights the range of pathologic findings that could be observed in gastrointestinal specimens from patients infected with coronavirus disease 2019 and the potential underlying pathogenetic mechanisms of this disease.

Gastrointestinal System: COVID-19 and Potential Mechanisms Associated with Coagulopathy

SARS-CoV-2 is a novel coronavirus that expanded worldwide, generating a pandemic of acute respiratory syndrome called "coronavirus disease 2019" (COVID-19), which resulted in a global health crisis. The spectrum of COVID-19 manifestations ranges from none or mild symptoms to severe respiratory failure associated with systemic manifestations, mostly gastrointestinal symptoms. Hypercoagulability is an important feature of COVID-19 disease, which can potentially influence patients' prognosis. Therefore, gastroenterologists should focus on subjects with concomitant hypercoagulable gastrointestinal disorders as they may display a higher risk of thrombotic complications during SARS-CoV-2 infection. The aim of this review is to summarize the available evidence regarding the interplay of the prothrombotic pathogenetic mechanisms of both COVID-19 and hypercoagulable digestive diseases and the possible clinical implications. We summarized the potential interplay of prothrombotic mechanisms of both COVID-19 and hypercoagulable digestive diseases in the graphical abstract.

Intraoperative discovery of melanosis coli during emergent bowel resection for perforation

A patient was taken to the operating room with a presumptive diagnosis of necrotic small bowel and colon. During the procedure, it was noted that she had black mucosa throughout the colon. Several factors suggested viable colonic tissue, and the decision was made to not resect the colon as originally planned. Final pathology of the specimen would later reveal melanosis coli, an ultimately benign diagnosis. Further questioning of the patient found that she had taken a herbal laxative supplement containing several components which are known to cause melanosis coli. We hope that this case report will serve as a reminder to surgeons and clinicians to remember melanosis coli as a clinical entity when confronted with blackened or darkened colonic mucosa. On review of available literature, we identified other cases in which melanosis coli was discovered intraoperatively, and we propose a number of factors to support intraoperative decision making.

Life-threatening gastrointestinal haemorrhage requiring surgical resection caused by SARS-CoV-2 induced ANCA associated vasculitis: A case report

Introduction and importance

SARS-CoV-2 infection has been linked to the de novo diagnosis of various autoimmune conditions as well as flares in pre-existing disease. With such high prevalence of SARS-CoV-2 in the community, it is important to consider rare manifestations of autoimmune conditions when patients present with severe symptoms. Multi-specialty care is required to ensure optimal outcomes and prompt diagnosis.

Case presentation

A 28-year-old male presented to our tertiary referral centre with progressive debilitating polyarthritis, a purpuric rash on both flanks and aphthous ulcers 6 weeks after infection with SARS-CoV-2. On the second day of admission, he developed severe gastrointestinal haemorrhage requiring multiple blood transfusions. Attempted angioembolisation failed to identify a site of active haemorrhage. On failing trial of conservative management, the decision was made to perform an exploratory laparotomy. The small bowel was found to have an extensive vasculitis requiring resection to control haemorrhage. Autoimmune serology revealed c-ANCA positivity with anti-PR3 antibodies.

Clinical discussion

Patients presenting with acute vasculitic pathologies related to SARS-CoV-2 have the potential to rapidly progress to severe life-threatening gastrointestinal haemorrhage. Prompt surgical management is appropriate in selected cases.

Conclusion

In the current era of COVID-19, the differential diagnosis of SARS-CoV-2 induced ANCA vasculitis must be considered for such cases with gastrointestinal haemorrhage. Compilation of similar cases and further studies are required to determine an optimal management pathway for these patients.

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SARS-CoV-2 has been associated with de novo autoimmune vasculitis.

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SARS-CoV-2 induced vasculitis can progress to severe intestinal bleeding.

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Surgical resection is paramount in refractory vasculitic gastrointestinal bleeding.

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Multi-speciality care is essential in cases of SARS-CoV-2 induced vasculitis.

COVID-19 and Intestinal Ischemia: A Multicenter Case Series

Introduction

Gastrointestinal symptoms are common among COVID-19 patients. Although gastrointestinal involvements are mostly benign, they rarely indicate a severe pathology like intestinal ischemia. The present case series describes 21 patients with bowel ischemia, necrosis, or perforation.

Methods

The present case series was conducted from April 2020 to February 2022 in the surgical wards of two Iranian hospitals. We retrospectively included adult patients with concomitant COVID-19 and intestinal ischemia. Primary outcomes were defined as the length of stay and survival.

Results

Twenty-four patients with a median age of 61.5 years were included in the study. Sixteen (67%) patients were male, and 13 (54%) were without any comorbidities. Macrovascular mesenteric ischemia was not identified in 21 patients (87.5%). Gastrointestinal manifestations appeared on the median of seven days (range 2–21) after the diagnosis of COVID-19, with the most common symptom being abdominal pain. All the patients had a significantly elevated C-Reactive Protein prior to surgery, ranging from 68 to 362. D-dimer was measured in eight patients and was significantly elevated, ranging from 1,878 to over 5,000 ng/mL. One patient was managed conservatively due to a good clinical condition. Except for one patient with angioinvasive mucormycosis and one other with leukocytoclastic vasculitis, pathologic evaluation revealed general features of intestinal necrosis, including ulcer, hemorrhage, necrosis, neutrophilic infiltration (in seven patients), neutrophilic abscess (in four patients), and edema. Bowel necrosis accompanied mortality of 15 (62.5%) patients and a median of 6.5 days of hospital stay.

Conclusion

Intestinal ischemia in COVID-19 patients is associated with a high mortality rate. Further research is needed to elucidate the dynamics of intestinal ischemia in the setting of COVID-19.