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. 2021 Dec;75(12):e14930.
doi: 10.1111/ijcp.14930. Epub 2021 Oct 10.

Bowel ischemia in COVID-19: A systematic review

Suyog Patel  1 , Charmy Parikh  2 , Deepak Verma  3 , Ramaswamy Sundararajan  4 , Upasana Agrawal  5 , Niharika Bheemisetty  6 , Radhika Akku  7 , Diana Sánchez-Velazco  8 , Madeeha Subhan Waleed  9
Affiliations

Bowel ischemia in COVID-19: A systematic review

Suyog Patel et al. Int J Clin Pract. 2021 Dec.

Abstract

Background: Gastrointestinal complications of COVID-19 have been reported over the last year. One such manifestation is bowel ischaemia. This study thus aims to provide a more holistic review of our current understanding of COVID-19-induced bowel ischaemia.

Method and results: A meticulous search was performed using different keywords in PubMed and Google Scholar. Fifty-two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25 702 patients were included in our study after the completion of the qualitative assessment.

Discussion: The common symptoms of GIT in COVID-19 patients are as diarrhoea, vomiting, nausea and abdominal pain. The mechanism of bowel ischaemia is associated with the formation of emboli which is related to COVID-19's high affinity for angiotensin-converting enzyme-2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients present with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute intestinal ischaemia (mesenteric). Management is usually initiated with gastric decompression, fluid resuscitation, and haemodynamic support. Surgical intervention is also sought.

Conclusion: Intestinal ischaemia presenting in patients with COVID-19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to triage patients with COVID-19 to suspect intestinal ischaemia and to help in diagnosis and management.

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Figures

FIGURE 1
FIGURE 1
PRISMA 2009 flow diagram
FIGURE 2
FIGURE 2
Flow chart of mechanisms of acute mesenteric ischaemia in COVID‐19. ACE‐2, angiotensin‐converting enzyme 2; IL‐6, interleukin‐6
FIGURE 3
FIGURE 3
Co‐relation of AGI with d‐dimer and CRP
See this image and copyright information in PMC

References

    1. Waleed MS, Sadiq W, Azmat M. Understanding the mosaic of COVID‐19: a review of the ongoing crisis. Cureus. 2020;12(3):e7366. 10.7759/cureus.7366. - DOI - PMC - PubMed
    1. Abou‐Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID‐19: incidence, pathophysiology, and management. Thromb Res. 2020;19:101‐115. 10.1016/j.thromres.2020.06.029. - DOI - PMC - PubMed
    1. Kaur S, Bansal R, Kollimuttathuillam S, et al. The looming storm: blood and cytokines in COVID‐19. Blood Rev. 2021;46:100743. - PMC - PubMed
    1. Kaur P, Posimreddy S, Singh B, Qaqa F, Habib HA, Maroules M. COVID‐19 presenting as acute limb ischaemia. Eur J Case Rep Intern Med. 2020;7(6):e001724. - PMC - PubMed
    1. Singh B, Kaur P, Ajdir N, Gupta S, Maroules M. COVID‐19 presenting as acute limb ischemia. Cureus. 2020;12(7):e9344. - PMC - PubMed

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