Gastro-Intestinal Bleeding in COVID-19 Patients - Is There Any Causal Relation?

The novel Severe Acute Respiratory Syndrome Coronavirus-2 has put an enormous pressure on health systems around the world. The large number of severe cases that had symptoms seemingly unrelated to the respiratory system, continues to create confusion. The digestive tract is not spared either. The most commonly reported digestive symptoms are nausea, vomiting, anorexia, diarrhea and, less frequently but with significant impact, gastrointestinal bleeding. The elderly population is the one more likely to develop severe anemia clinically expressed by hematemesis, melena or hematochezia. From our experience and as we concluded from literature, men confirmed with COVID-19 have a higher risk of developing digestive haemorrhage. The upper gastro-intestinal tract, defined as the digestive segment above the Treitz angle, is more often affected. The gastro-duodenal ulcers are the main cause found in COVID-19 patients with digestive bleeding. In addition, the patients with SARS-COV2 infection and gastro-intestinal bleeding most commonly associate with other comorbidities such as hypertension and diabetes.

Haemobilia - A Rare Cause of Upper Gastro-Intestinal Bleeding.

Haemobilia is a rare cause of upper gastrointestinal bleeding that consists of haemorrhage within the biliary tree. Most cases of haemobilia are due to iatrogenic cause, laparoscopic or open cholecystectomy, abdominal trauma, gallstones, hepatic tumours, vascular aneurism. We present the case of a male patient admitted in the surgery department for epigastric and right hypochondria pain, nausea and vomiting. Open cholecystectomy was performed with a trans-cystic tube drainage. Postoperative outcome was favourable but with a continuous decrease in haemoglobin level. In the 13th day postoperatively biliary drainage was 800 ml - haemobilia. Patient health status altered and melena and hematemesis occurred. Endoscopy, cholangiography and abdominal computer tomography (CT) were performed. The episode repeated in day 27 after initial surgery. Duodenotomy and exploration of the biliary tree was performed. Angiography was performed next day that revealed biliary-arterial fistula within segment IV of the liver followed by embolization. Haemobilia reoccurred fifteen days later and colonoscopy and angiography were performed. Embolization with metallic coils was performed. Patient outcome was favourable and was discharged 13 days after second embolization. Interventional angiography remains the first treatment option of haemobilia. Selective arterial ligation or hepatectomy remain the options in case of lack of angiography or insufficient results after embolization.