COVID-19 News: South Korean Doctors Warn That SARS-CoV-2 Can Cause Gastric Ischemia!

COVID-19 News: As the world deals with the complexities of the ongoing COVID-19 pandemic, medical professionals are discovering novel manifestations of the virus that extend beyond its initial characterization as a respiratory illness. In a groundbreaking revelation, South Korean doctors from Inje University Haeundae Paik Hospital and Chungang University Gwangmyung Hospital report a unique case linking severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to gastric ischemia (GaI). This unexpected connection sheds light on the intricate interplay between COVID-19 and its potential impact on diverse organ systems.


 
While many claim that gastric ischemia as a result of SARS-CoV-2 is a rare phenomenon, there is growing evidence from published case reports, studies and even COVID-19 News coverages that such incidences are not that rare and worse, with the emergence of the JN.1 variant, there are growing reports of more gastrointestinal issues including gastric ischemia.
 
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https://www.mdpi.com/2077-0383/11/1/200
 
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https://www.sciencedirect.com/science/article/pii/S2210261221006076
 
https://www.cureus.com/articles/69751-acute-mesenteric-ischemia-as-an-early-complication-of-covid-19#!/
 
https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00793-x
 
Understanding Gastric Ischemia
Gastric ischemia, a rare condition characterized by inadequate blood supply to t he stomach, poses diagnostic challenges due to the organ's robust collateral blood supplies. Typically, the stomach is less susceptible to ischemic events due to its multiple vascular sources. However, when GaI occurs between the esophagus and duodenum, it transforms into a serious medical concern. Symptoms mirror those of other gastrointestinal disorders, including abdominal pain, nausea, vomiting, and bleeding. Known causes encompass sepsis, severe atherosclerosis, vasculitis, acute gastric distension, and gastric volvulus.
 
Recent case reports underscore a potential link between SARS-CoV-2 infection and acute gastrointestinal ischemia, primarily affecting the small bowel and colon. Notably, the onset of ischemia in these cases occurs within 1 to 13 days post-COVID-19 infection, indicating a swift and severe impact on the gastrointestinal system. The multifactorial nature of gastrointestinal ischemia involves inflammation, microvascular endotheliopathy, and a hypercoagulable state induced by SARS-CoV-2 infection. COVID-19 has been associated with a heightened risk of thrombotic complications, including microvascular thrombosis, venous thrombosis, and stroke.
 
Case Presentation: A Disturbing Sequence of Events
The reported case involves a 65-year-old man with a medical history marked by chronic kidney disease and diabetes mellitus. Initially presenting with typical COVID-19 symptoms such as high fever, cough, and weakness, the patient's condition deteriorated despite initial medical interventions. His clinical picture evolved into a complex scenario involving metabolic acidosis, necessitating continuous renal replacement therapy and hemodialysis.
 
On the 20th day of hospitalization, the patient experienced excruciating abdominal pain, prompting further investigation. Abdominal computed tomography (CT) revealed gastric pneumatosis, indicating the presence of gas in the stomach wall and suggesting a potential perforation. This alarming finding led to an emergency laparoscopic exploration on the 21st day of hospitalization.
 
The laparoscopic examination uncovered an edematous stomach with a concerning "blue" color change, indicative of low blood perfusion or gastric ischemia. Further complicating the situation was the presence of bloody ascites in the abdomen, signaling internal bleeding. Surprisingly, despite the ominous signs, there was no evidence of perforation in the gastric wall or other parts of the digestive tract.
 
Discussion: Unraveling the Complexities of Gastric Ischemia in COVID-19
Gastric ischemia, typically documented in isolated case reports, presents a diagnostic conundrum due to its rarity and diverse clinical presentations. Recent literature highlights the distinctive nature of COVID-19-related ischemia, often involving thrombosis in small vessels rather than mechanical pressure or anatomical abnormalities.
 
Noteworthy in this case is the occurrence of GaI in large vessels surrounding the stomach, deviating from the expected involvement of organs with smaller vessels. The paradoxical severity observed in the patient, despite the stomach having fewer angiotensin-converting enzyme 2 (ACE2) receptors, raises intriguing questions about the virus's specific impact on gastric blood supply. Additionally, the delayed onset of GaI suggests unique triggers, distinct from the acute shock symptoms associated with cytokine storms in COVID-19 patients.
 
Diagnosis and Treatment Dilemmas: Navigating Uncharted Territory
Diagnosing GaI involves a combination of imaging techniques, including CT scans and gastroscopy, with surgical exploration reserved for severe cases. However, the distinctive features of COVID-19-related ischemia, characterized by thrombosis in small vessels, add complexity to the diagnostic process.
 
The reported case posed a unique challenge in terms of treatment decisions. Despite indications of gastric perforation on imaging, surgery was contraindicated for GaI. Regrettably, the delayed realization that the appropriate approach was supportive care, rather than surgical intervention, compromised the patient's prognosis.

Future Research and Conclusions: Unraveling the Mysteries of COVID-19 Complications
Regrets over the lack of an autopsy and stomach biopsy underscore the need for comprehensive research to elucidate the causal relationship between SARS-CoV-2 and GaI. Molecular markers for ACE2 receptors could provide insights into the specific mechanisms triggering GaI post-COVID-19 infection.
 
In conclusion, this unprecedented case serves as a critical reminder of the evolving understanding of COVID-19's impact on various organ systems. Healthcare professionals must maintain a heightened suspicion for GaI in COVID-19 patients presenting with severe abdominal pain. Conservative treatment should be prioritized, with surgery considered only when absolutely necessary.
 
The complexities revealed in this case emphasize the need for continuous vigilance and research to comprehend the intricate manifestations of COVID-19 and optimize patient care. As the medical community grapples with the ongoing challenges posed by the pandemic, each case provides valuable insights that contribute to our collective understanding of the virus and its repercussions on human health.
 
The case report was published in the peer reviewed journal: Life
https://www.mdpi.com/2075-1729/14/1/47
 
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