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Open Access 01-12-2022 | Hematoma | Research

Ischemic and hemorrhagic abdominal complications in COVID-19 patients: experience from the first Italian wave

Authors: Pietro Andrea Bonaffini, Paolo Niccolò Franco, Alice Bonanomi, Cinzia Giaccherini, Clarissa Valle, Paolo Marra, Lorenzo Norsa, Marina Marchetti, Anna Falanga, Sandro Sironi

Published in: European Journal of Medical Research | Issue 1/2022

Abstract

Purpose

To report ischemic and haemorrhagic abdominal complications in a series of COVID-19 patients. To correlate these complications with lung involvement, laboratory tests, comorbidities, and anticoagulant treatment.

Methods

We retrospectively included 30 COVID-19 patients who undergone abdomen CECT for abdominal pain, between March 16 and May 19, 2020. Ischemic and haemorrhagic complications were compared with lung involvement (early, progressive, peak or absorption stage), blood coagulation values, anticoagulant therapy, comorbidities, and presence of pulmonary embolism (PE).

Results

Ischemic complications were documented in 10 patients (7 receiving anticoagulant therapy, 70%): 6/10 small bowel ischemia (1 concomitant obstruction, 1 perforation) and 4/10 ischemic colitis. Main mesenteric vessels were patent except for 1 superior mesenteric vein thrombosis. Two ischemia cases also presented splenic infarctions. Bleeding complications were found in 20 patients (all receiving anticoagulant treatments), half with active bleeding: hematomas in soft tissues (15) and retroperitoneum (2) and gastro-intestinal bleeding (3). Platelet and lymphocyte were within the normal range. d-Dimer was significantly higher in ischemic cases (p < 0.001). Most of the patients had severe lung disease (45% peak, 29% absorption), two patients PE.

Conclusions

Ischemic and haemorrhagic abdominal complications may occur in COVID-19 patients, particularly associated to extended lung disease. CT plays a key role in the diagnosis of these potentially life- threatening conditions.

Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017–32. https://doi.org/10.1038/s41591-020-0968-3.CrossRefPubMed

Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A. Extrapulmonary manifestations of COVID-19: radiologic and clinical overview. Clin Imaging. 2020;66:35–41. https://doi.org/10.1016/j.clinimag.2020.05.013.CrossRefPubMedPubMedCentral

Gu SX, Tyagi T, Jain K, Gu VW, Lee SH, Hwa JM, Kwan JM, Krause DS, Lee AI, Halene S, Martin KA, Chun HJ, Hwa J. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol. 2021;18(3):194–209. https://doi.org/10.1038/s41569-020-00469-1.CrossRefPubMed

Miesbach W, Makris M. COVID-19: coagulopathy, risk of thrombosis, and the rationale for anticoagulation. Clin Appl Thromb Hemost. 2020;26:1076029620938149. https://doi.org/10.1177/1076029620938149.CrossRefPubMedPubMedCentral

Datta PK, Liu F, Fischer T, Rappaport J, Qin X. SARS-CoV-2 pandemic and research gaps: Understanding SARS-CoV-2 interaction with the ACE2 receptor and implications for therapy. Theranostics. 2020;10(16):7448–64. https://doi.org/10.7150/thno.48076.CrossRefPubMedPubMedCentral

Livanos AE, Jha D, Cossarini F, Gonzalez-Reiche AS, Tokuyama M, Aydillo T, Parigi TL, Ladinsky MS, Ramos I, Dunleavy K, Lee B, Dixon RE, Chen ST, Martinez-Delgado G, Nagula S, Bruce EA, Ko HM, Glicksberg BS, Nadkarni G, Pujadas E, Reidy J, Naymagon S, Grinspan A, Ahmad J, Tankelevich M, Bram Y, Gordon R, Sharma K, Houldsworth J, Britton GJ, Chen-Liaw A, Spindler MP, Plitt T, Wang P, Cerutti A, Faith JJ, Colombel JF, Kenigsberg E, Argmann C, Merad M, Gnjatic S, Harpaz N, Danese S, Cordon-Cardo C, Rahman A, Schwartz RE, Kumta NA, Aghemo A, Bjorkman PJ, Petralia F, van Bakel H, Garcia-Sastre A, Mehandru S. Intestinal host response to SARS-CoV-2 infection and COVID-19 outcomes in patients with gastrointestinal symptoms. Gastroenterology. 2021;160(7):2435-2450.e34. https://doi.org/10.1053/j.gastro.2021.02.056.CrossRefPubMed

Perico L, Benigni A, Casiraghi F, Ng LFP, Renia L, Remuzzi G. Immunity, endothelial injury and complement-induced coagulopathy in COVID-19. Nat Rev Nephrol. 2021;17(1):46–64. https://doi.org/10.1038/s41581-020-00357-4.CrossRefPubMed

Marchetti M, Gomez-Rosas P, Sanga E, Gamba S, Verzeroli C, Russo L, Restuccia F, Schieppati F, Bonanomi E, Rizzi M, Fagiuoli S, D’Alessio A, Lorini L, Falanga A. Endothelium activation markers in severe hospitalized COVID-19 patients: role in mortality risk prediction. TH Open. 2021;5(3):e253–63. https://doi.org/10.1055/s-0041-1731711.CrossRefPubMedPubMedCentral

Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, Bolling MC, Dijkstra G, Voors AA, Osterhaus AD, van der Voort PH, Mulder DJ, van Goor H. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;251(3):228–48. https://doi.org/10.1002/path.5471.CrossRefPubMedPubMedCentral

10.

Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol. 2021;93(1):250–6. https://doi.org/10.1002/jmv.26232.CrossRefPubMed

11.

Zhang J, Garrett S, Sun J. Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19. Genes Dis. 2021;8(4):385–400. https://doi.org/10.1016/j.gendis.2020.08.013.CrossRefPubMed

12.

Norsa L, Bonaffini PA, Indriolo A, Valle C, Sonzogni A, Sironi S. Poor outcome of intestinal ischemic manifestations of COVID-19. Gastroenterology. 2020;159(4):1595-1597.e1. https://doi.org/10.1053/j.gastro.2020.06.041.CrossRefPubMed

13.

Perisetti A, Gajendran M, Mann R, Elhanafi S, Goyal H. COVID-19 extrapulmonary illness—special gastrointestinal and hepatic considerations. Dis Mon. 2020;66(9):101064. https://doi.org/10.1016/j.disamonth.2020.101064.CrossRefPubMedPubMedCentral

14.

Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, Catalano O, Gee MS, Hahn PF, Harisinghani M, Kilcoyne A, Lee SI, Mojtahed A, Pandharipande PV, Pierce TT, Rosman DA, Saini S, Samir AE, Simeone JF, Gervais DA, Velmahos G, Misdraji J, Kambadakone A. Abdominal imaging findings in COVID-19: preliminary observations. Radiology. 2020;297(1):E207–15. https://doi.org/10.1148/radiol.2020201908.CrossRefPubMed

15.

Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, Goodarzi K, Bendapudi PK, Bornikova L, Gupta S, Leaf DE, Kuter DJ, Rosovsky RP. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489–500. https://doi.org/10.1182/blood.2020006520.CrossRefPubMed

16.

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, Clark C, Iba T. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023–6. https://doi.org/10.1111/jth.14810.CrossRefPubMed

17.

Pan F, Ye T, Sun P, Gui S, Liang B, Li L, Zheng D, Wang J, Hesketh RL, Yang L, Zheng C. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715–21. https://doi.org/10.1148/radiol.2020200370.CrossRefPubMed

18.

Norsa L, Bonaffini PA, Caldato M, Bonifacio C, Sonzogni A, Indriolo A, Valle C, Furfaro F, Bonanomi A, Franco PN, Gori M, Smania V, Scaramella L, Forzenigo L, Vecchi M, Solbiati M, Costantino G, Danese S, D’Antiga L, Sironi S, Elli L. Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study. World J Gastroenterol. 2021;27(32):5448–59. https://doi.org/10.3748/wjg.v27.i32.5448.CrossRefPubMedPubMedCentral

19.

Funt SA, Cohen SL, Wang JJ, Sanelli PC, Barish MA. Abdominal pelvic CT findings compared between COVID-19 positive and COVID-19 negative patients in the emergency department setting. Abdom Radiol. 2021;46(4):1498–505. https://doi.org/10.1007/s00261-020-02796-w.CrossRef

20.

Barkmeier DT, Stein EB, Bojicic K, Otemuyiwa B, Vummidi D, Chughtai A, Ellis JH. Abdominal CT in COVID-19 patients: incidence, indications, and findings. Abdom Radiol. 2021;46(3):1256–62. https://doi.org/10.1007/s00261-020-02747-5.CrossRef

21.

Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438–40. https://doi.org/10.1016/S2352-3026(20)30145-9.CrossRefPubMedPubMedCentral

22.

Gómez-Mesa JE, Galindo-Coral S, Montes MC, Muñoz Martin AJ. Thrombosis and coagulopathy in COVID-19. Curr Probl Cardiol. 2021;46(3):100742. https://doi.org/10.1016/j.cpcardiol.2020.100742.CrossRefPubMed

23.

Musoke N, Lo KB, Albano J, Peterson E, Bhargav R, Gul F, DeJoy R 3rd, Salacup G, Pelayo J, Tipparaju P, Azmaiparashvili Z, Patarroyo-Aponte G, Rangaswami J. Anticoagulation and bleeding risk in patients with COVID-19. Thromb Res. 2020;196:227–30. https://doi.org/10.1016/j.thromres.2020.08.035.CrossRefPubMedPubMedCentral

24.

Paranjpe I, Fuster V, Lala A, Russak A, Glicksberg B, Levin M, et al. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J Am Coll Cardiol. 2020;6:122–4. https://doi.org/10.1016/j.jacc.2020.05.001.CrossRef

25.

Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE, Abosalif KOA, Ahmed Z, Younas S. COVID-19 and comorbidities: deleterious impact on infected patients. J Infect Public Health. 2020;13(12):1833–9. https://doi.org/10.1016/j.jiph.2020.07.014.CrossRefPubMedPubMedCentral

26.

Callender LA, Curran M, Bates SM, Mairesse M, Weigandt J, Betts CJ. The impact of pre-existing comorbidities and therapeutic interventions on COVID-19. Front Immunol. 2020;11(11):1991. https://doi.org/10.3389/fimmu.2020.01991.CrossRefPubMedPubMedCentral

Title: Ischemic and hemorrhagic abdominal complications in COVID-19 patients: experience from the first Italian wave
Authors: Pietro Andrea Bonaffini
Paolo Niccolò Franco
Alice Bonanomi
Cinzia Giaccherini
Clarissa Valle
Paolo Marra
Lorenzo Norsa
Marina Marchetti
Anna Falanga
Sandro Sironi
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Hematoma
Anticoagulant
COVID-19
Thrombosis
Published in: European Journal of Medical Research / Issue 1/2022
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-022-00793-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ischemic and hemorrhagic abdominal complications in COVID-19 patients: experience from the first Italian wave

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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