Introduction: Although Coronavirus Disease 2019 (COVID-19) primarily presents with fever and respiratory symptoms, gastrointestinal manifestations are increasingly recognized as part of the disease spectrum. Through potentially overlapping pathophysiology, co-occurrence of COVID-19 and first-time acute diverticulitis has been reported. Our study seeks to further characterize the association between COVID-19 and first-time acute diverticulitis in unvaccinated individuals.
Methods: Unvaccinated patients diagnosed with COVID-19 who subsequently developed acute diverticulitis within 30 days (n=41, age 62.7 ±15.5 years, 46% male) were identified between 2020-2022. COVID-19 and acute diverticulitis was diagnosed by PCR and computer tomography respectively. Patients with prior history of acute diverticulitis were excluded. Patient characteristics and comorbid conditions were collected. Characterization of COVID-19 course (treatment setting, medical/ventilatory therapy) and acute diverticulitis (treatment setting, complications, therapy) was performed.
Results: Of 41 patients, 56% (23/41) were hospitalization for COVID-19 (13.6 ±10.7 days), with 10 requiring non-invasive ventilation and 4 requiring invasive ventilation. Mean duration between COVID-19 diagnosis and acute diverticulitis was 14.3 ±9.6 days. Complications of acute diverticulitis occurred in 65.9% (27/41) of patients, with 73.2% (30/41) requiring hospitalization and 24.4% (10/41) requiring emergent surgery. The most common complication was intestinal perforation (43.9%, 18/41), followed by abscess formation (36.6%, 15/41), peritonitis (19.5%, 8/41), and fistula formation (4.9%, 2/41). Patients hospitalized for COVID-19 were more likely to develop intestinal perforation (47.8% vs. 38.9%) and peritonitis (30.4% vs. 5.6%) vs. non-hospitalized patients, likely reflecting more severe COVID-19 disease course.
Discussion: COVID-19 is thought to cause intestinal injury though a combination of inflammation-mediated endothelial damage, interstitial edema, and microvascular injury. Our study indicates that patients diagnosed with first-time acute diverticulitis within 30-days of COVID-19 infection have an elevated complication rate, most commonly intestinal perforation and abscess formation. The incidence of perforation was further elevated in hospitalized patients, with marked elevation in peritonitis incidence. Given the increased all-cause complication rate, future large-scale studies are indicated to evaluate the potential benefit of early intervention.
