Gastrointestinal Complications and Vascular Events Associated with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is primarily a respiratory illness, but mounting evidence reveals significant gastrointestinal (GI) involvement and a strong proclivity for vascular complications. Gastrointestinal manifestations range from mild anorexia, nausea and diarrhoea to acute surgical emergencies such as acute cholecystitis and mesenteric ischaemia. Many patients display prothrombotic features, driven by endothelial dysfunction, cytokine‐mediated inflammation and hypercoagulability, leading to thromboembolic events in medium‐ and large‐sized vessels supplying abdominal organs. Pathological examination has demonstrated viral persistence in intestinal tissues and endotheliitis within visceral vessels, implicating direct viral invasion and immune‐mediated vascular injury. Clinically, GI symptoms often present alongside or even before respiratory signs, complicating diagnosis and delaying intervention. Imaging modalities, especially contrast‐enhanced computed tomography, have been indispensable in detecting bowel wall compromise, portal vein thrombosis and organ infarction. Understanding the interplay between dysregulated coagulation, endothelial injury and gastrointestinal pathology is paramount for timely anticoagulation strategies, surgical decision‐making and optimisation of supportive care.

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Gastrointestinal Complications and Vascular Events Associated with COVID-19 publication trend

The graph below shows the total number of articles in gastrointestinal complications and vascular events associated with covid-19 across all publications each year (not limited to Nature Index journals).

Technical terms

Hypercoagulability: A state in which the blood has an increased tendency to form clots, often driven by inflammatory cytokines and endothelial injury.

Mesenteric ischaemia: A reduction of blood flow to the small or large intestine, leading to tissue hypoxia, infarction and potential bowel necrosis.

Portal vein thrombosis: Formation of a blood clot within the portal vein, impairing blood drainage from the intestines and causing portal hypertension or infarction.

Endotheliitis: Inflammation of the endothelial lining of blood vessels, which can compromise vascular integrity and promote thrombosis.

Acute cholecystitis: Sudden inflammation of the gallbladder, which in COVID-19 may result from ischaemic injury to the gallbladder wall rather than gallstone obstruction.

References

1. A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications. Biomedicines (2023).
2. Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia. Viruses (2024).
3. Acute Mesenteric Ischemia in COVID-19 Patients. Journal of Clinical Medicine (2021).