PDF(Pubmed)
Abstract：
Ischemic colitis is a disease in which local tissue in the intestinal wall dies to varying degrees due to insufficient blood supply to the colon. Risk factors include cardiovascular disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, etc. Typical clinical manifestations of the disease are abdominal pain and hematochezia. The most common locations are the watershed areas of splenic flexure and rectosigmoid junction. The lesions are segmental and clearly demarcated from normal mucosa under endoscopy. The digestive tract is a common extra-pulmonary organ affected by the novel coronavirus, which can be directly damaged by the virus or indirectly caused by virus-mediated inflammation and hypercoagulability. The corona virus disease 2019 (COVID-19) associated intestinal injury can be characterized by malabsorption, malnutrition, intestinal flora shift, etc. CT can show intestinal ischemia, intestinal wall thickening, intestinal wall cystoid gas, intestinal obstruction, ascites, intussusception and other signs. In this study, we reported a case of ischemic colitis in a moderate COVID-19 patient. The affected area was atypical and the endoscope showed diffuse lesions from the cecum to the rectosigmoid junction. No signs of intestinal ischemia were found on imaging and clear thrombosis in small interstitial vessels was found in pathological tissue. Combined with the fact that the patient had no special risk factors in his past history, the laboratory tests indicated elevated ferritin and D-dimer, while the autoantibodies and fecal etiology results were negative, we speculated that the hypercoagulability caused by novel coronavirus infection was involved in the occurrence and development of the disease in this patient. After prolonged infusion support and prophylactic anti-infection therapy, the patient slowly resumed diet and eventually went into remission. Finally, we hoped to attract clinical attention with the help of this case of moderate COVID-19 complicated with ischemic colitis which had a wide range of lesions and a slow reco-very. For patients with abdominal pain and blood in the stool after being diagnosed as COVID-19, even if they are not severe COVID-19, they should be alert to the possibility of ischemic colitis, so as not to be mistaken for gastrointestinal reactions related to COVID-19.
摘要：
缺血性结肠炎是由于结肠供血不足导致肠壁局部组织不同程度死亡的疾病。危险因素包括心血管疾病，糖尿病,慢性肾病,慢性阻塞性肺疾病,等。该病的典型临床表现为腹痛和便血。最常见的位置是脾弯曲和直肠乙状结肠交界处的分水岭区域。在内窥镜检查下，病变是节段性的，与正常粘膜清晰分界。消化道是受新型冠状病毒影响的常见肺外器官，它可以被病毒直接损害或由病毒介导的炎症和高凝状态间接引起。2019年冠状病毒病（COVID-19）相关的肠道损伤可表现为吸收不良，营养不良,肠道菌群转移，等。CT可以显示肠缺血,肠壁增厚，肠壁囊样气体，肠梗阻,腹水,肠套叠和其他体征。在这项研究中,我们报道了1例中度COVID-19患者发生缺血性结肠炎的病例.受影响的区域不典型，内窥镜显示从盲肠到直肠乙状结肠交界处的弥漫性病变。影像学上未发现肠缺血征象，病理组织中发现小间质血管有明显的血栓形成。结合患者既往史无特殊危险因素,实验室测试表明铁蛋白和D-二聚体升高，而自身抗体和粪便病因结果均为阴性，我们推测新型冠状病毒感染引起的高凝状态参与了该患者疾病的发生和发展。经过长时间的输液支持和预防性抗感染治疗，患者缓慢恢复饮食并最终缓解.最后,我们希望借助这例中度COVID-19并发缺血性结肠炎的病例引起临床关注，该病例病变范围广，复发缓慢。对于确诊为COVID-19后出现腹痛和便血的患者，即使不是严重的COVID-19，也要警惕缺血性结肠炎的可能，以免被误认为与COVID-19相关的胃肠道反应。
