Ischemic Colitis in a Patient with Severe COVID-19 Pneumonia

Abstract

At the time of the current COVID-19 pandemic, on a daily basis, we encountered patients suffering from various manifestations of this infection. The most common are respiratory symptoms. Many of the patients require acute hospital care, and a smaller group of them are hospitalized in intensive care units. A subset of these critically ill patients demonstrates clinically remarkable hypercoagulability and thus a predisposition to venous and arterial thromboembolism, manifested by thrombotic events ranging from acute pulmonary embolism and splanchnic vascular ischemia to extremity ischemia. The article describes a case of a patient with COVID-19 pneumonia complicated by massive bleeding into the gastrointestinal tract due to ischemic enterocolitis in connection with COVID-19 infection.

Keywords: Acute abdomen; COVID-19; Ischemic colitis; Thrombembolism.

Fig. 1

Chest X-ray: diffusely thickened lung pattern, paracardial to confluent on the left − character of inflammatory infiltration. The left diaphragm is blurred (photo: author's archive).

Fig. 2

CT angiography of abdomen with i.v. and p.o. contrast − area of distended caecum up to 80 mm, without wall thickening, with dense liquid intestinal content (photo: author's archive).

Fig. 3

Detail of the small-intestine mucosa: erosions and neutrophilic infiltration of the superficial epithelial layer − possible sign of ischemic enteritis. Standard hematoxylin-eosin staining, magnification, ×40 (photo: author's archive).

Fig. 4

Detail of colonic mucosa with visible sharp cutoff changing into ulceration. Standard hematoxylin-eosin staining, magnification, ×40 (photo: author's archive).

Fig. 5

Detail of colonic ulceration richly permeated with erythrocytes. Visible is a vessel with fibrin thrombus in the lumen (thrombi in vessels together with changes such as erosions or ulcerations are assuming ischemic etiology of the lesion). Standard hematoxylin-eosin staining, magnification, ×100 (photo: author's archive).

Fig. 6

CT angiography of the abdomen with p.o. and i.v. contrast − area of the caecum with apparent lipomatosis of the Bauhin's valve (photo: author's archive).

Fig. 7

Detail of the area of Bauhin's valve with lipomatosis: a visible partition of the intact crypts of the colonic mucosa and ulceration. Inflammatory and reparative changes at the base of the ulceration affect the adipocytes. Standard hematoxylin-eosin staining, magnification, ×100 (photo: author's archive).