tetano
Editor, Senior Moderator
Oxf Med Case Reports
. 2023 Apr 20;2023(4)
mad031.
doi: 10.1093/omcr/omad031. eCollection 2023 Apr.
Ischemia-induced intestinal de-epithelization and consequent cholangitis lenta after usage of extracorporeal membrane oxygenation in COVID-19 patients: an autopsy series
Sae Hatanaka[SUP] 1 [/SUP], Yuki Yamada[SUP] 1 [/SUP], Terufumi Kubo[SUP] 1 [/SUP], Kazufumi Magara[SUP] 1 [/SUP], Yusuke Ono[SUP] 1 [/SUP], Shintaro Sugita[SUP] 2 [/SUP], Tomohide Tsukahara[SUP] 1 [/SUP], Daisuke Kyuno[SUP] 1 [/SUP], Michiko Hosaka[SUP] 2 [/SUP], Kenta Sasaki[SUP] 1 [/SUP], Yoshihiko Hirohashi[SUP] 1 [/SUP], Tsukasa Yamakawa[SUP] 3 [/SUP], Keisuke Harada[SUP] 4 [/SUP], Naofumi Bunya[SUP] 4 [/SUP], Eichi Narimatsu[SUP] 4 [/SUP], Hiroshi Nakase[SUP] 3 [/SUP], Tadashi Hasegawa[SUP] 2 [/SUP], Makoto Osanai[SUP] 1 [/SUP], Toshihiko Torigoe[SUP] 1 [/SUP]
Affiliations
Abstract
Since its discovery in late 2019, severe acute respiratory syndrome coronavirus 2 has spread around the world, causing millions of deaths due to coronavirus disease 2019 (COVID-19). Numerous clinical and post-mortem investigations of COVID-19 cases have found myriad clinical and pathological manifestations of the disease. In this report, we present three autopsy cases in which, despite weaning from extracorporeal membrane oxygenation (ECMO), extensive intestinal epithelial shedding, probably due to ischemia, was followed by massive watery diarrhea and the spread of infection via the portal vein due to bacterial translocation, which resulted in cholangitis lenta. Thrombophilia was attributed to ECMO usage and COVID-19-related vascular endothelial damage. These cases provide instructive findings showing that the loss of the intestinal barrier may be the underlying cause of severe watery diarrhea and liver failure in COVID-19 patients, especially with ECMO usage.
. 2023 Apr 20;2023(4)
mad031.doi: 10.1093/omcr/omad031. eCollection 2023 Apr.
Ischemia-induced intestinal de-epithelization and consequent cholangitis lenta after usage of extracorporeal membrane oxygenation in COVID-19 patients: an autopsy series
Sae Hatanaka[SUP] 1 [/SUP], Yuki Yamada[SUP] 1 [/SUP], Terufumi Kubo[SUP] 1 [/SUP], Kazufumi Magara[SUP] 1 [/SUP], Yusuke Ono[SUP] 1 [/SUP], Shintaro Sugita[SUP] 2 [/SUP], Tomohide Tsukahara[SUP] 1 [/SUP], Daisuke Kyuno[SUP] 1 [/SUP], Michiko Hosaka[SUP] 2 [/SUP], Kenta Sasaki[SUP] 1 [/SUP], Yoshihiko Hirohashi[SUP] 1 [/SUP], Tsukasa Yamakawa[SUP] 3 [/SUP], Keisuke Harada[SUP] 4 [/SUP], Naofumi Bunya[SUP] 4 [/SUP], Eichi Narimatsu[SUP] 4 [/SUP], Hiroshi Nakase[SUP] 3 [/SUP], Tadashi Hasegawa[SUP] 2 [/SUP], Makoto Osanai[SUP] 1 [/SUP], Toshihiko Torigoe[SUP] 1 [/SUP]
Affiliations
- PMID: 37091687
- PMCID: PMC10120430
- DOI: 10.1093/omcr/omad031
Abstract
Since its discovery in late 2019, severe acute respiratory syndrome coronavirus 2 has spread around the world, causing millions of deaths due to coronavirus disease 2019 (COVID-19). Numerous clinical and post-mortem investigations of COVID-19 cases have found myriad clinical and pathological manifestations of the disease. In this report, we present three autopsy cases in which, despite weaning from extracorporeal membrane oxygenation (ECMO), extensive intestinal epithelial shedding, probably due to ischemia, was followed by massive watery diarrhea and the spread of infection via the portal vein due to bacterial translocation, which resulted in cholangitis lenta. Thrombophilia was attributed to ECMO usage and COVID-19-related vascular endothelial damage. These cases provide instructive findings showing that the loss of the intestinal barrier may be the underlying cause of severe watery diarrhea and liver failure in COVID-19 patients, especially with ECMO usage.