Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group ( p < 0.0001). Age over 60 years ( p = 0.043) and the need for surgery ( p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.
【저자키워드】 COVID-19, SARS-CoV-2, Cytokines, hypercoagulability, Endothelitis, Acute mesenteric ischemia, thromboemboembolism, 【초록키워드】 Hospitalized, SARS-COV-2 infection, surgery, CRP, outcome, risk factor, Laboratory, viability, management, Thromboembolism, understanding, ICU Patients, information, patients, mechanism, COVID-19 patients, association, Ischemia, Leukocytosis, Thromboprophylaxis, Pathways, Artery, anticoagulant therapy, C reactive protein, Microvascular thrombosis, Web of Science, Vascular, hospitalized COVID-19 patients, help, article, duplication, offer, bowel, feature, intestinal, Fluid management, affected, involved, reported, was performed, adjust, 【제목키워드】 Mesenteric,