Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study

Lorenzo Norsa, Pietro Andrea Bonaffini, Maja Caldato, Cristiana Bonifacio, Aurelio Sonzogni, Amedeo Indriolo, Clarissa Valle, Federica Furfaro, Alice Bonanomi, Paolo Niccolò Franco, Mauro Gori, Veronica Smania, Lucia Scaramella, Laura Forzenigo, Maurizio Vecchi, Monica Solbiati, Giorgio Costantino, Silvio Danese, Lorenzo D'Antiga, Sandro SironiLuca Elli

Research output: Contribution to journalArticlepeer-review


BACKGROUND Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19). AIM To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection. METHODS A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID- 19 between March 1st and May 30th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed. RESULTS Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%. CONCLUSION Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.

Original languageEnglish
Pages (from-to)5448-5459
Number of pages12
JournalWorld Journal of Gastroenterology
Issue number32
Publication statusPublished - Aug 28 2021


  • Coronavirus
  • COVID-19
  • Endothelial inflammation
  • Ischemic colitis
  • Small bowel ischemia

ASJC Scopus subject areas

  • Gastroenterology


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