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1.
Tomography ; 8(3): 1228-1240, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1820401

ABSTRACT

(1) Background: Spontaneous retroperitoneal hematomas are a relatively common occurrence in hospitalized patients with COVID-19 related pneumonia, and endovascular treatment of trans-arterial embolization (TAE) may be a life-saving procedure after failure of medical and supportive therapy. The aim of our study was to evaluate spontaneous retroperitoneal hematomas in the COVID-19 era, focusing on their imaging features at CTA and DSA and on the safety, as well as technical and clinical success, of TAE, comparing patients affected by COVID-19 and non-COVID-19 patients. (2) Materials and Methods: We retrospectively enrolled 24 patients with spontaneous retroperitoneal hematoma who underwent TAE; of these, 10 were hospitalized for COVID-19-related pneumonia, while the other 14 were without COVID-19 infection. We evaluated the demographic data, hemoglobin values before and after the procedure, preprocedural aPTT, preprocedural INR, diagnostic and interventional imaging findings, procedural outcome (technical success) and survival periprocedural (clinical success), and major and minor complications. (3) Results: The mean age of the study population was 72.7 ± 11.2 years. CTA revealed signs of active bleeding in 20 patients (83%). DSA showed signs of active bleeding in 20 patients (83%). In four patients (17%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 17 patients (71%), while seven patients (29%) rebled within 96 h, and all of them were retreated. No major periprocedural complication was reported. The comparison between the two groups did not show statistically significant differences for gender, mean age, mean pre- and postprocedural hemoglobin, aPTT and INR, mean hematoma volume (cm3), or mean delay between CT and DSA. Active bleeding at CTA was detected in 90% of COVID-19 patients and 79% of non-COVID-19 patients (p = 0.61). At DSA, active bleeding was assessed in eight out of 10 (80%) patients in the COVID-19 group and 12 out of 14 (86%) patients in the non-COVID-19 group (p = 1). Technical success was obtained in 100% of patients in both groups. Clinical success rates were 70% for COVID-19 group and 71% for the non-COVID-19 group. We found no statistical significance between the clinical success rates of retroperitoneal spontaneous hematoma embolization in patients with or without SARS-CoV-2 infection. (4) Conclusions: We suggest that, similar to what has been reported in other studies in non-COVID-19 patients, TAE should be considered an important safe, effective, and potentially life-saving option for the management and the treatment of patients affected by COVID-19 who present with spontaneous retroperitoneal hematoma and who could not benefit from conservative treatment.


Subject(s)
COVID-19 , Aged , Aged, 80 and over , COVID-19/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Hematoma/diagnostic imaging , Hematoma/etiology , Hematoma/therapy , Humans , Middle Aged , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
3.
J Gastroenterol Hepatol ; 37(5): 878-882, 2022 May.
Article in English | MEDLINE | ID: covidwho-1691504

ABSTRACT

BACKGROUND AND AIM: Changes to endoscopy service availability during the COVID-19 pandemic may have affected management of upper gastrointestinal bleeding (UGIB). The aim of this study was to describe the impact of the pandemic on UGIB outcomes in the Toronto area in Canada. METHODS: We described all adults admitted to general medicine wards or intensive care units at six hospitals in Toronto and Mississauga, Canada, with UGIB during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) and compared them with a historical cohort (March 1 to June 30, 2018 and 2019). We compared clinical outcomes (in-hospital mortality, length of stay, 30-day readmission, intensive care utilization, receipt of endoscopy, persistent bleeding, receipt of second endoscopy, and need for angiographic or surgical intervention) using multivariable regression models, controlling for demographics, comorbidities, and severity of clinical presentation. RESULTS: There were 82.5 and 215.5 admissions per month for UGIB during the COVID-19 and control periods, respectively. There were no baseline differences between groups for demographic characteristics, comorbidities, or severity of bleeding. Patients in the COVID-19 group did not have significantly different unadjusted (3.9% vs 4.2%, P = 0.983) or adjusted mortality (adjusted odds ratio [OR] = 0.64, 95% confidence interval [CI] = 0.25-1.48, P = 0.322). Patients in COVID-19 group were less likely to receive endoscopy for UGIB in the unadjusted (61.8% vs 71.0%, P = 0.003) and adjusted (adjusted OR = 0.64, 95% CI = 0.49-0.84, P < 0.01) models. There were no differences between groups for other secondary outcomes. CONCLUSIONS: While patients admitted for UGIB during the first wave of the pandemic were less likely to receive endoscopy, this had no impact on mortality or any secondary outcomes.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hospital Mortality , Humans , Pandemics , Retrospective Studies
6.
Minerva Gastroenterol (Torino) ; 67(4): 307-309, 2021 12.
Article in English | MEDLINE | ID: covidwho-1187222
8.
Am J Trop Med Hyg ; 104(1): 63-65, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1067875

ABSTRACT

Clinical manifestations and complications of SARS-CoV-2 are still emerging and variant. Gastrointestinal (GI) manifestations and complications are hugely under-recognized. The presence of angiotensin converting enzyme-2 receptors in the intestinal enterocytes, the receptors primarily involved in the pathogenesis of COVID-19 pneumonia, maybe the key factor contributing to the pathogenesis of GI manifestations. Ischemic colitis, although the most common ischemic pathology of the GI tract, is relatively rare, occurring as a result of colonic hypoperfusion. The innumerable causes of colonic ischemia are categorized into occlusive and nonocclusive pathologies. Here, we have discussed a case of severe COVID-19 pneumonia, developing ischemic colitis, as a rare GI complication. The cause of ischemia in COVID-19 pneumonia is multifactorial, including hypercoagulable state, coagulopathy leading to thromboembolic complications, and use of vasopressors in severely ill patients with hemodynamic compromise.


Subject(s)
COVID-19/complications , Colitis, Ischemic/etiology , SARS-CoV-2 , Aged , COVID-19/therapy , Colitis, Ischemic/therapy , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Male
12.
Endoscopy ; 52(11): 1036-1038, 2020 11.
Article in English | MEDLINE | ID: covidwho-900029

ABSTRACT

BACKGROUND: COVID-19 has spread rapidly around the world. The Austrian government implemented a lockdown on 16 March to contain further spread of the disease. We investigated the effects of lockdown on acute upper gastrointestinal (GI) bleeding in Austria. METHODS: We contacted 98 Austrian hospitals performing emergency endoscopies. The hospitals were asked to report upper GI endoscopies performed for recent hematemesis, melena, or both, and exhibiting endoscopically visible signs of bleeding. The study period was from 3 weeks before (calendar Week 9) to 3 weeks after (Week 14) initiation of the lockdown. RESULTS: 61 % of Austrian hospitals, and importantly all major state hospitals, responded. A total of 575 upper GI bleedings occurred during the 3 weeks before and 341 during the 3 weeks after initiation of lockdown (40.7 % reduction). There was a 54.6 % decline in nonvariceal bleeding events at Week 14 compared with Week 9 (89 vs. 196), whereas rates of variceal hemorrhage did not change (15 vs. 17). CONCLUSIONS: National lockdown resulted in a dramatic decrease in upper GI bleeding events in Austrian hospitals.


Subject(s)
Betacoronavirus , Communicable Disease Control , Coronavirus Infections/prevention & control , Esophageal and Gastric Varices/epidemiology , Gastrointestinal Hemorrhage/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Social Isolation , Austria , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Endoscopy , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/therapy , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2
15.
BMC Gastroenterol ; 20(1): 318, 2020 Sep 29.
Article in English | MEDLINE | ID: covidwho-800931

ABSTRACT

BACKGROUND: SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including nausea, diarrhea, and vomiting. Massive gastrointestinal bleeding, however, has rarely been reported. CASE PRESENTATION: We herein described a case of severe SARS-CoV-2 infected patient with several risk factors for poor prognosis, including male, hypertension, old age, mixed bacterial infection and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia was uncontrolled. The patient rapidly deteriorated, suffered from cardiac arrest, and expired. CONCLUSIONS: Digestive symptoms could be severe in SARS-CoV-2 infected patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection through faecal-oral transmission should be implemented in the process of patient care and infection control.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/mortality , Gastrointestinal Hemorrhage/virology , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Aged, 80 and over , COVID-19 , Coronavirus Infections/therapy , Fatal Outcome , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/therapy , Humans , Male , Pandemics , Pneumonia, Viral/therapy , Risk Factors , SARS-CoV-2
17.
Mil Med Res ; 7(1): 45, 2020 09 23.
Article in English | MEDLINE | ID: covidwho-781559

ABSTRACT

BACKGROUND: Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. CASE PRESENTATION: We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. CONCLUSION: When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Diarrhea/therapy , Gastrointestinal Hemorrhage/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Aged , COVID-19 , Coronavirus Infections/diagnosis , Diarrhea/etiology , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Humans , Immunization, Passive/methods , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Recurrence , Sampling Studies , Severity of Illness Index , Taiwan , Treatment Outcome
18.
Korean J Intern Med ; 35(5): 1027-1030, 2020 09.
Article in English | MEDLINE | ID: covidwho-646555

ABSTRACT

Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.


Subject(s)
Algorithms , Betacoronavirus , Coronavirus Infections/epidemiology , Emergency Service, Hospital , Endoscopy , Patient Selection , Pneumonia, Viral/epidemiology , COVID-19 , Cholangitis/diagnosis , Cholangitis/etiology , Cholangitis/therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Foreign Bodies/diagnosis , Foreign Bodies/etiology , Foreign Bodies/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Republic of Korea , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
20.
Am J Gastroenterol ; 115(10): 1609-1616, 2020 10.
Article in English | MEDLINE | ID: covidwho-717821

ABSTRACT

INTRODUCTION: Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized. METHODS: This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches. RESULTS: There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance. DISCUSSION: In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Gastrointestinal Hemorrhage/epidemiology , Peptic Ulcer/epidemiology , Pneumonia, Viral/complications , Rectal Diseases/epidemiology , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Blood Transfusion/statistics & numerical data , COVID-19 , Case-Control Studies , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/virology , Endoscopy/statistics & numerical data , Enema/adverse effects , Enema/instrumentation , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hemostatic Techniques/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Peptic Ulcer/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Rectal Diseases/etiology , Rectal Diseases/therapy , Risk Factors , SARS-CoV-2
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