Case Report: Paralytic Ileus: A Potential Extrapulmonary Manifestation of Severe COVID-19.
Case Report: Paralytic Ileus: A Potential Extrapulmonary Manifestation of Severe COVID-19.
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DOI：
10.4269/ajtmh.20-0894
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Al-Shokri SD
中科院分区：
文献类型：
--
作者：
Ibrahim YS;Karuppasamy G;Parambil JV;Alsoub H;Al-Shokri SD
COVID-19疫情最近在全球蔓延，主要以肺炎或其他呼吸道疾病的形式出现。此外，越来越多的报告称胃肠道表现是该病毒的肺外特征之一。我们报告两例SARS-CoV-2感染并发麻痹性肠梗阻。第一名患者是一名33岁的男子，他因严重的COVID-19肺炎住院，需要呼吸机支持和重症监护。他出现大肠扩张和中横结肠穿孔，并接受了剖腹手术和结肠切除术。切除的肠标本的组织学显示急性炎症、坏死和出血，支持COVID-19诱导的微血栓形成导致穿孔的作用。第二名患者是一名33岁的男性，患有严重的COVID-19肺炎、肾衰竭和急性胰腺炎。住院期间并发麻痹性肠梗阻，经保守治疗后好转。观察到两例病例均存在肝转氨酶升高，这与其他研究一致。几位作者假设，血管紧张素转换酶2受体（COVID-19的宿主受体）存在于小肠和大肠的肠上皮细胞上，可能介导病毒进入并导致炎症。这是严重COVID-19感染病例中麻痹性肠梗阻的潜在机制。认识到麻痹性肠梗阻作为一种可能的并发症，需要及时诊断和管理。
The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19–induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.
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