Bilateral covid pneumonia and intestinal ischemia, an analysis of our experience

ABSTRACT

Aim: COVID-19 is mostly well known because of its respiratory pathology, nevertheless several ischemic complications have been reported during the pandemia. The aim of this report is to present 9 cases of acute intestinal ischemia in patients with concomitant SARS-COV- 2 bilateral pneumonia. Method(s) We present a case series collected from a retrospective database, that includes 9 patients with intestinal ischemia and bilateral COVID 19 pneumonia diagnosed during the years 2020 and 2022 at the "Hospital Universitario Nuestra Senora de Candelaria." Results: Of the 9 patients, 6 were men with a mean age of 63 years, 5 of them unvaccinated and 2 with partial dose. All presented with bilateral covid pneumonia requiring admission and intubation at the intensive care unit. During admission, after a hemodynamic worsening with increasing lactate, acute intestinal ischemia was diagnosed on a CT scan (7 non occlusive and 2 occlusive ischemia of the SMA). 7 of them underwent damage control surgery of whom only 2 survived. The remaining 3, died hours after diagnosis, not undergoing surgical treatment due to poor short-term prognosis. Conclusion(s) The severe inflammatory response along with a hypercoagulable state secondary to COVID 19 is responsible for many severe ischemic diseases such as intestinal ischemia. These can go unnoticed in intubated critically ill patients, or with concomitant respiratory disease due to the absence of obvious clinical manifestations. Given its high mortality, it is essential to take this differential diagnosis into account, to obtain an early diagnosis and treatment.