Severe bowel complications in SARS-CoV-2 patients receiving protocolized care

• Published in: Revista de Gastroenterología de México (English Edition) 2021-10, Vol.86 (4), p.378-386
• Main Authors: Estevez-Cerda, S.C., Saldaña-Rodríguez, J.A., Alam-Gidi, A.G., Riojas-Garza, A., Rodarte-Shade, M., Velazco-de la Garza, J., Leyva-Alvizo, A., Gonzalez-Ruvalcaba, R., Martinez-Resendez, M.F., Ortiz de Elguea-Lizarraga, J.I.
• Format: Article
• Language: English
• Subjects: Bowel perforation; COVID-19; Isquemia mesentérica; Mesenteric ischemia; Mesenteric thrombosis; Perforación intestinal; Trombosis mesentérica
• ISSN: 2255-534X; 2255-534X
• DOI: 10.1016/j.rgmxen.2021.08.009

A case series of ten patients that received protocolized care for SARS-CoV-2 infection and developed severe gastrointestinal complications, is presented. The aim of our study was to contribute to the ongoing discussion regarding gastrointestinal complications related to SARS-CoV-2 infection. After reviewing the current literature, ours appears to be the first detailed case series on the topic. A retrospective filtered search of all patients admitted to our hospital for SARS-CoV-2 infection, who developed severe gastrointestinal complications, was performed. All relevant data on hospital patient management, before and after surgery, were collected from the medical records. Of the 905 patients admitted to our hospital due to SARS-CoV-2 infection, as of August 26, 2020, ten of them developed severe gastrointestinal complications. Seven of those patients were men. There were four cases of perforation of the proximal jejunum, three cases of perforations of the ascending colon, one case of concomitant perforation of the sigmoid colon and terminal ileum, one case of massive intestinal necrosis, and one preoperative death. Three right colectomies, four intestinal resections, one Hartmann’s procedure with bowel resection, and one primary repair of the small bowel were performed. The mortality rate of the patients analyzed was 50%. Spontaneous bowel perforations and acute mesenteric ischemia are emerging as severe, life-threatening complications in hospitalized SARS-CoV-2 patients. More evidence is needed to identify risk factors, establish preventive measures, and analyze possible adverse effects of the current treatment protocols. Presentamos una serie de casos de diez pacientes recibiendo manejo protocolizado para infección por SARS-CoV-2 que desarrollaron complicaciones gastrointestinales severas. El objetivo del estudio es contribuir a la discusión sobre las complicaciones gastrointestinales de la infección por SARS-CoV-2. Hasta el momento y tras una revisión de la literatura, se trata de la primera serie de casos detallada sobre este tema. Se realizó una búsqueda retrospectiva y filtrada de todos los pacientes ingresados en nuestro hospital por infección por SARS-CoV-2 que desarrollaron complicaciones gastrointestinales severas. Se obtuvieron del expediente clínico todos los datos relevantes al manejo intrahospitalario antes y después de la cirugía. De 905 pacientes ingresados a la fecha del 26 de agosto de 2020 en nuestro hospital por infección por SARS-CoV-2