ECHOGRAPHIC CHARACTERISTICS OF THE COLON IN PATIENTS WITH PSEUDOMEMBRANOUS COLITIS IN CASE OF COVID-19

Abstract

Objectives. To analyze the colon echographic images of patients suffering from pseudomembranous colitis (PMC) with COVID-19. Material and methods. 24 patients with PMC and COVID-19 (group 1), 24 patients with COVID-19 infection without diarrhea (group 2) and 24 practically healthy subjects (group 3, the control one) were examined. The diagnosis of coronavirus infection was verified by isolating SARS-CoV-2 RNA by polymerase chain reaction from the mucous membrane of the upper respiratory tract. Clostridioides difficile infection was detected by means of an immunochromatographic test with the determination of microbial toxins in the feces of patients. Ultrasound investigation (US) was performed using convex 3.5-4.0 MHz and linear 9.0-10.0 MHz probes without special preparation of patients for the examination. Results. All patients of group 1 had a thickened colon wall from 3.5 up to 11.2 mm. Among the patients of the 2nd group, the thickness of the intestinal wall in 25% of cases was up to 2 mm inclusively, in 75% - 2.1 mm or more, of which in every fourth case it exceeded 3 mm. The thickness of the bowel wall between the 1st and the 2nd groups of patients, as well as the 1st and the 3rd groups of patients, had statistically significant differences, no such pattern was found between the 2nd and the 3rd groups. The progression of ultrasound signs of colon lesions in patients suffering from PMC with COVID-19 was accompanied by a worsening of their clinical condition and the aggravation of characteristic laboratory changes. With a positive response to PMC therapy regression of ultrasound changes in the intestinal wall occurs, but there is some delay in the normalization of structural changes recorded by ultrasound. In all cases of PMC with COVID-19, a loss or weakening of the stratification of the bowel wall is observed. Tocompletion of PMC treatment when the intestinal wall thickness exceeds 4.5 mm is accompanied by the occurrence of relapses. Conclusions. Ultrasound of the intestine in patients having PMC with COVID-19 makes it possible to objectify the condition of the bowel wall and to adjust the management of patients.