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Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience
- Source :
- The American surgeon. 87(12)
- Publication Year :
- 2021
-
Abstract
- Background COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution’s surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period. Methods All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included. Data from the medical records were analyzed. Results Twenty patients were included. Eighty percent had a new or increasing vasopressor requirement, 70% had abdominal distension, and 50% had increased gastric residuals. Intra-operatively, ischemia affected the large bowel in 80% of cases, the small bowel in 60%, and both in 40%. Sixty five percent had an initial damage control laparotomy. Most of the resected bowel specimens had a characteristic appearance at the time of surgery, with a yellow discoloration, small areas of antimesenteric necrosis, and very sharp borders. Histologically, the bowel specimens frequently have fibrin thrombi in the small submucosal and mucosal blood vessels in areas of mucosal necrosis. Overall mortality in this cohort was 33%. Forty percent of patients had a thromboembolic complication overall with 88% of these developing a thromboembolic phenomenon despite being on prophylactic pre-operative anticoagulation. Conclusion Bowel ischemia is a potentially lethal complication of COVID-19 infection with typical gross and histologic characteristics. Suspicious clinical features that should trigger surgical evaluation include a new or increasing vasopressor requirement, abdominal distension, and intolerance of gastric feeds.
- Subjects :
- Male
medicine.medical_specialty
Necrosis
Exploratory laparotomy
medicine.medical_treatment
Ischemia
Fibrin
medicine
Humans
Laparotomy
biology
business.industry
SARS-CoV-2
Medical record
COVID-19
General Medicine
Abdominal distension
Middle Aged
medicine.disease
Surgery
Intestinal Diseases
Massachusetts
Cohort
biology.protein
Female
medicine.symptom
business
Complication
Subjects
Details
- ISSN :
- 15559823
- Volume :
- 87
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- The American surgeon
- Accession number :
- edsair.doi.dedup.....7aa9e8f9c83caf93a221df27510ce38f