Colon ischemia in patients with severe COVID-19: A single-center retrospective cohort study of 20 patients
Open accessAbstract
Purpose Thromboembolic complications due to COVID-19 are common in patients requiring critical care and are associated with high morbidity and mortality rates. The aim of this study was to evaluate clinical manifestations and postoperative outcomes after colectomy for COVID-19-associated colonic ischemia in the first versus the second wave of the pandemic.Methods A retrospective cohort study of patients with severe COVID-19 at our institution between 1 March 2020 and 31 January 2021 was performed. All patients with severe COVID-19, requiring critical care and surgical treatment of colonic ischemia, were included. The main outcomes were surgical complications and mortality rate.Results A total of 190 patients were included of whom 20 (10.5%) patients underwent surgery for colon ischemia. Preoperatively, D-dimer was elevated, especially in the first wave (median 15.24 (interquartile range 6.00-32.00) vs. 2.09 (1.42-4.28) mg/L, p = 0.025). Twelve (60%) patients underwent a (sub)total colectomy, 7 (35%) a right hemicolectomy, and one patient (5%) an ileocecal resection. Grade 3b complications occurred in one of 5 patients (20%) in the first and in 9 of 15 patients (60%) in the second wave. The overall in-hospital mortality was similar in both waves (40% vs. 47%), with death occurring after a median stay of 21 days.Conclusion In this cohort study of patients with severe COVID-19 and colonic ischemia, clinical presentation and laboratory findings varied. However, the majority of patients required (sub)total colectomy. Despite a lower threshold to surgery in the second wave, mortality remained high.
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Among the 36 articles, 6 retrospective studies documented intestinal ischemia in 55 patients admitted to intensive care units with COVID-19 pneumonia for whom surgical consult was necessary.
“Among these, we identified 6 retrospective studies [16,17,18,19,20,21], documenting intestinal ischemia in 55 patients admitted to intensive care units (ICU) with COVID-19 pneumonia for whom surgical consult was necessary (Table 1).”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [18]
Prolonged stay in intensive care, intubation, and the need for vasopressor medication was associated with increased risk of acute bowel ischemia.
“Prolonged stay in intensive care, intubation, and the need for vasopressor medication was associated with increased risk of acute bowel ischemia [8,18,19].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [18]
Obesity might be considered a possible risk factor, with a reported mean BMI of 31.2-32.5 in hospitalized patients.
“Obesity might be considered a possible risk factor, with a reported mean BMI of 31.2–32.5 in hospitalized patients [16,18,19].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [18]
Several authors described in acute bowel ischemia encountered in ICU patients with COVID-19 a distinct yellowish color, rather than the typical purple or black color of ischemic bowel, predominantly located at the antimesenteric side or circumferentially with affected areas well delineated from the adjacent healthy areas.
“Several authors described in acute bowel ischemia encountered in ICU patients with COVID-19, a distinct yellowish color, rather than the typical purple or black color of ischemic bowel, predominantly located at the antimesenteric side or circumferentially with affected areas well delineated from the adjacent healthy areas [18,19].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [18]
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Acute mesenteric ischemia in COVID-19 patients
Serban, D., Tribus, L. C., Vancea, G., Stoian, A. P., Dascalu, A. M., Suceveanu, A. I., Tanasescu, C., Costea, A. C., Tudosie, M. S., Tudor, C., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm11010200 · Cited by 46 · see citing works
COVID-19 and intestinal ischemia: a multicenter case series
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- Authors
- Yang, C., Hakenberg, P., Weiß, C., Herrle, F., Rahbari, N., Reißfelder, C., & Hardt, J.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Hardt, Julia
- Venue
- International Journal of Colorectal Disease
- Published
- 2021-07-29
- Volume
- 36
- Issue
- 12
- Pages
- 2769-2773
- ISSN
- 0179-1958 (ISSN-L)
- 1432-1262
- PMC
- PMC8319884
- OpenAlex
- W3184385494
- Cited by
- 7
- References
- 12
- Citations by year
- 2023: 1 · 2022: 5 · 2021: 1
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Colorectal Disease (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- COVID-19 pandemic, ischemic colitis, colectomy, thromboembolic events, D-dimer, postoperative complications, in-hospital mortality, first and second pandemic waves, intensive care
- MeSH terms
- COVID-19, SARS-CoV-2, Colectomy, Colon, Humans, Ischemia, Retrospective Studies, Cohort Studies
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