In the second wave of COVID19, we have seen several virus mutations and their impact has been tremendous on human health and wellbeing. Apart from respiratory infections, patients are presenting with gastrointestinal symptoms such as diarrhea, nausea/ vomiting, anorexia, abdominal pain, abnormal liver enzymes. Moreover, COVID19 increases the chances of Coagulopathy (a condition in which the blood’s ability to form clots is impaired), especially in patients with severe disease. We are seeing a marginal rise in cases of Intestinal Gangrene caused by Mesenteric Thrombosis in patients with COVID19. Researchers have found evidence that indicates that the Gastrointestinal Tract is an important portal of entry, and a possible site of the persistent source of infection via prolonged fecal shedding with concurrent gastrointestinal symptoms. Also Read - Breaking News LIVE Updates: UP Police Sends Legal Notice to Twitter India MD Over Ghaziabad Attack
Dr Hemant A. Patil, Advanced Laparoscopic & Gastrointestinal Surgeon, Fortis Hospital Mulund shares his inputs on the rare intestinal gangrene, its causes, symptoms, and the link between COVID-19 and gangrene. Also Read - Third COVID Wave Unlikely to Affect Children in India, Finds WHO-AIIMS Study
What is Intestinal Gangrene?
Intestinal Gangrene involves a short or long segment of your small intestines. This type of gangrene occurs when blood flow to the small intestine is blocked — due to pressure from outside on the blood supplying artery/ blockage of the artery. Two causes of intestine gangrene are external pressure in cases of strangulated hernia and the Second one is intestine gangrene due to blockage of the mesenteric artery which is internal blockages and this is what we are seeing in covid patients. If left untreated, intestinal gangrene can be deadly and fatal. Also Read - Sergio Ramos Admits he Wanted to Stay at Real Madrid But Offer Had Expiry Date
What are the causes of Gangrene?
Several situations cause Gangrene to develop, including a lack of blood flow to the extremities or severe infection of an extremity. If Gangrene involves the Intestine, it is called Intestinal Gangrene. There are a number of risk factors that increase the chances of developing this condition; some of which include;
- Injury of the vessel/ arteries in the Intestine
- Strangulation of intestine/ bowel in the hernia
- Blockage of an artery leading the Intestine
- Long standing uncontrolled Diabetes Mellitus
- Chronic smoking
- Old age
- Dyslipidemia (having blood lipid levels that are too high )
Symptoms to Watch out for :
The symptoms of Intestinal Gangrene typically include abdominal pain (mild to severe), bloating, vomiting, diarrhea, blood in stools/ dark coloured stools, fever. Other symptoms include-
- Abdominal distension
What is the link between COVID and Intestinal Gangrene?
COVID19 lowers immunity and the patient’s ability to fight disease. People with uncontrolled Diabetes, Obesity and extremely lowered immunity are at higher risk. Moreover, Hypercoagulopathy (when blood forms a clot when it shouldn’t ) increases the changes of Pulmonary Embolism, Deep Vein Thrombosis (DVT) and also Mesenteric Artery Thrombosis. Now, there are various theories discussed by researchers, but no definite cause is obtained so far.
How does one diagnose it?
Early detection is extremely crucial for early interventions. Patients with COVID19 whose symptoms are highly suspicious, need to be investigated for Intestinal Gangrene. A CT scan of the abdomen with Angiography to identify blockages is important.
What are the treatments available?
Blood thinners are the main treatment for this condition in early stages. If you have a blood clotting disorder, you may need to take blood thinners indefinitely. In some cases, such as when a blood clot is discovered in the Mesenteric Veins/ Artery, blood thinners can be delivered directly to the clot through a procedure called Thrombolysis. Other treatment modules include;
- Low-Molecular-Weight Heparin (LMWH)
- Intravascular Thrombolysis
- In some cases where Intestinal Gangrene already established, surgical intervention is a must
Prevention is the best defense:
COVID19 vaccines are supposed to trigger immune responses to fight against the virus and help reduce complications related to COVID19. The most important factor is prevention. Follow these guidelines to ensure you don’t get Intestinal Gangrene:
- Eat healthy, eat right
- Weight reduction (speak to your physician about this)
- Keep control of your Diabetes
- Stop Tobacco consumption
- Exercise regularly
- Don’t ignore symptoms
- Wear a mask when around infected people or while venturing out
- Maintain social distancing
- Use sanitiser judiciously
- Seek early help from your doctor if any abdominal symptoms