engleski

COVID-19 manifestations on small intestine: a case report

Introduction and Aim: The acute Covid-19 infection can cause changes, not only on respiratory system, but on many other organs (1, 2). According to recent findings it is reasonable to assume that endothelial dysfunction contributes to COVID-19- associated vascular inflammation, particularly endotheliitis, in the lung, heart, kidney and intestine, as well as COVID-19-associated coagulopathy, particularly pulmonary fibrinous microthrombi in the alveolar capillaries (3), and in our case also in the intestine (ACE2 receptor is expressed on endothelial cells (ECs) in the lung, heart, kidney, and intestine). The aim of this case report is to present the clinical case that can combine the relationship of COV-19 infection and changes of small intestine integrity during infection period (1-3). Methods: We present the female patient 81 years old who had severe form of COVID-19 infection. During previous hospitalization in other Clinical hospital, several times she underwent to upper gastrointestinal endoscopy and on colonoscopy due to suspected gastrointestinal bleeding. They performed three upper gastrointestinal endoscopies and one colonoscopy (without terminal ileum intubation). In this hospital, they made doubt that she was bleeding from small intestine. Because of severe form of clinical infection, she was transmitted to our University hospital, ICU- COVID department. After the patient was stable, we continued with endoscopic gastrointestinal investigations and that included three upper endoscopy procedures and push small intestine endoscopy procedure (enteroscopy, Olympus). There were no findings of GI bleeding, but MCST angiography, that our Radiology Department performed, was highly suggested of jejunum bleeding. Therefore we decided to use the Oylmpus video endo-capsule system. Results: On video endo- capsule procedure, , we detected multiple submucosal hematomas and bleeding erosions in the middle part of small intestine, what resolved the diagnostic problem. Two selected photos are presented in Figure 1. Figure 1. The video endo- capsule image of small intestine: left submucosal hematoma of jejunum, and right vascular mucosal defects of jejunum Conclusion: This case indicate the possible influence of SARS-CoV-2 infection on small intestine mucosa integrity and coagulation. The further research is needed in order to confirm the preliminary results and elucidate the possible mechanisms. Reference: 1. Gupta A, Madhaven MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nature Medicine 2020 ; 26:1017-1032. 2. Leal T, Costa E, Arroja B, Goncalves R, Alves J. Gastrointestinal manifestations of COVID- 19: results from a European centre. Eur J Gastroenterol and hepatol 2021 ; 33(5):691691. 3. Zhang J, Tecson KM, McCullough AP. Endothelial dysfunction contributes to COVID-19- associated vascular inflammation and coagulopathy. Rev Cardiovasc Med 2020 ; Sep 30 ; 21(3):315-319. PMID: 33070537 ; doi: 10.31083/j.rcm.2020.03.126.S

COVID-19 ; small intestine

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