Colonic Gangrene: A Sequela of Coronavirus Disease 2019

Abstract

Initially considered to be a respiratory disease, coronavirus disease 2019 (COVID-19) is now recognized as a multisystem disease known to affect all the major organs, including the gastrointestinal system. Based on recent studies, severe acute respiratory syndrome coronavirus 2 causes dysregulation of multiple biological pathways, triggers an exaggerated immune response, and affects multiple organs. The gastrointestinal symptoms in COVID-19 are common but often overlooked. We report the case of a 50-year-old female with a recent history of COVID-19 presenting with complaints of abdominal pain and constipation. Initially, the patient was treated for respiratory symptoms and discharged home. Subsequently, she was re-admitted and diagnosed with colonic obstruction on radiology. Laparotomy revealed descending and sigmoid colonic gangrene requiring left colectomy. This case highlights the uncommon but severe gastrointestinal manifestations of COVID-19.

Keywords: bowel gangrene; colectomy; covid-19; intestinal ischemia; sars-cov-2; sigmoid colon; small vessel vasculitis.

Figure 1. CT of the chest showing centrilobular ground glass opacities involving both the lungs and suggestive of COVID-19 pneumonia (A) and grossly dilated sigmoid colon with imperceptible posterior wall (arrows) (B).

CT: computed tomography; COVID-19: coronavirus disease 2019

Figure 2. The macroscopic appearance of the descending colon from the serosal side (A) and the mucosal side (B) showing a distinct line of demarcation between healthy and ischemic bowel segments. Microscopic examination of the resected colon revealed denuded and sloughed mucosal surface (H&E, ×10) (C). The medium-sized arteries in the mesocolon showed inflammatory changes in their walls with foci of necrosis suggestive of vasculitis (H&E, ×40) (D).

H&E: hematoxylin and eosin