A Series of COVID-19 Cases With Findings in the Gastrointestinal and Hepatobiliary System.

Dongling Wu,Lili Lee,Sean Hacking

doi:10.7759/cureus.22602

Abstract

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide. Most of the infected patients present with respiratory symptoms and acute lung damage. Here, we present three cases of patients with COVID-19 disease whose main clinical manifestations are gastrointestinal symptoms. In our first case, we present a COVID-19 patient with histologic findings associated with ischemic necrosis of the small bowel. In the second and third cases, we demonstrate acute cholecystitis and histology showing microvascular thrombosis. These three cases highlight the ischemic and thrombotic changes seen in the setting of COVID-19 infection without classic respiratory symptoms, with resulting severe gastrointestinal and hepatobiliary disease requiring surgical management. Although the bile or stool viral load was not tested in these patients, the small intestine and gallbladder were infected with SARS-CoV-2, most likely via the epithelial angiotensin-converting enzyme 2 (ACE2) receptor.

Highlights

Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) is a novel virus that belongs to the coronavirus family, causing coronavirus disease-2019 (COVID-19) [1], a disease first discovered in Wuhan, China in December 2019 which quickly led to an ongoing pandemic
We summarize findings from the gastrointestinal and hepatobiliary systems of three SARS-CoV-2 infected patients, two of whom presented with acute calculous cholecystitis
Ni et al reported that SARS-CoV-2 attaches to cells via the angiotensin-converting enzyme 2 (ACE2) entry receptor, which is widely expressed on endothelial cells [10]

Summary

Introduction

Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) is a novel virus that belongs to the coronavirus family, causing coronavirus disease-2019 (COVID-19) [1], a disease first discovered in Wuhan, China in December 2019 which quickly led to an ongoing pandemic. Histological examination of the ileum, appendix, and right colon revealed ischemic enteritis featuring active ileitis, mucosal ulceration, fibrinopurulent exudates, and foci of complete transmural necrosis (Figure 1a, How to cite this article Wu D, Hacking S, Lee L (February 25, 2022) A Series of COVID-19 Cases With Findings in the Gastrointestinal and Hepatobiliary System. Histologic examination showed features of transmural acute inflammation infiltrates indicating cholecystitis with mucosal ulceration and fibrinopurulent exudates (Figure 2a, 2b), areas of complete transmural necrosis, and multiple foci of submucosal vascular thrombi (Figure 2c, 2d). A 72-year-old female with a past medical history significant for Churg-Strauss syndrome, hereditary hemorrhagic telangiectasia with epistaxis, and small bowel angioectasias was initially hospitalized for SARS-CoV-2 infection, which was complicated by an acute arteriovenous fistula with anemia requiring multiple transfusions During hospitalization, she developed right upper quadrant abdominal pain.

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Disclosures