Intestinal Ischemia: Unusual but Fearsome Complication of COVID-19 Infection

Abstract

The pathophysiology of gastrointestinal damage in coronavirus disease (COVID-19) is probably multifactorial. It is not clear whether the etiology of intestinal ischemia may be directly related to viral replication or may result from hyper-coagulability following SARS-CoV-2 infection.To confirm a pathogenic role of COVID-19, we retrospectively investigated the presence of SARS-CoV-2 virus in the ischemic bowel of five COVID-19 patients undergoing emergency surgery for intestinal ischemia in the period of March 2020-May 2021. Immunohistochemical positivity with weak intensity was observed in four out of five cases, but only one case was strongly positive both at immunohistochemistry and at molecular analysis. The histological alterations in the intestinal tissue samples showed similarity with the well-known alterations described in typical targetorgans of the virus (e.g., the lung). This observation suggests a similar mechanism of action of the virus. Further larger studies are, thus, required to confirm this preliminary finding. Clinicians should carefully monitor all COVID-19 patients for the possible presence of a SARS-CoV-2 intestinal infection, a potential cause of ischemia and bowel perforation.

Keywords: COVID-19; SARS-CoV-2; bowel ischemia; thromboembolism.

Figure 1

(Hematoxylin-eosin staining; original magnification, 10×) Photomicrograph of the small intestine shows widespread inflammatory infiltrate in the lamina propria and in the submucosal layer (A) as well as perivascular (B). Immunohistochemistry, anti-SARS-CoV-2 spike glycoprotein (C), and SARS nucleocapsid protein antibody (D): extensive and well-defined cytoplasmic, supranuclear (arrow) immunostaining in the mucosal epithelial cells.