Document Type : Case reports

Authors

1 School of medicine, Isfahan University of Medical Science, Isfahan, Iran

2 Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Obstetrics and gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a major health problem worldwide. Vascular thrombosis is increasingly observed in COVID-19 patients. This complication seems to be due to coagulopathy and endothelial damage. In this paper, we report a COVID-19 patient with superior mesenteric artery thrombosis and review of 27 COVID-19 cases with acute mesenteric ischemia (AMI).
Case presentation: A 59-years old man with confirmed COVID-19 readmitted to the hospital due to abdominal pain and diarrhea two days after discharge from the emergency department. He was diagnosed with acute mesenteric ischemia by abdominal CT scan with contrast. The patient underwent emergency laparotomy and the ischemic gangrenous bowel was resected. Unfortunately, the patient succumbed one month after the operation.
Conclusion: AMI is a life-threatening thrombotic event rarely seen in COVID-19 patients, so it is vital to diagnose it. Anticoagulant and anti-inflammatory prophylactic therapies might be useful in preventing AMI, especially in the patients with thrombosis risk factor. So, it is crucial to reduce its incidence in COVID-19 patients.

Keywords

  1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-1062. doi: 10.1016/S0140-6736(20)30566-3
  2. Parry AH, Wani AH, Yaseen M. Acute mesenteric ischemia in severe coronavirus-19 (covid-19): possible mechanisms and diagnostic pathway. Acad Radiol. 2020;27(8):1190. doi: 10.1016/j.acra.2020.05.016 [PMID: 32475635]
  3. Karna ST, Panda R, Maurya AP, Kumari S. Superior mesenteric artery thrombosis in covid-19 pneumonia: an underestimated diagnosis-first case report in asia. Indian J Surg. 2020; 82(6):1235-1237. doi: 10.1007/s12262-020-02638-5 [PMID: 33100738]
  4. Lawson RM. Mesenteric Ischemia. Crit Care Nurs Clin North Am. 2018;30:29-39. doi: 10.1016/j.cnc.2017.10.003 [PMID: 29413213]5. Zettervall SL, Lo RC, Soden PA, Deery SE, Ultee KH, Pinto DS, et al. Trends in treatment and mortality for mesenteric ischemia in the united states from 2000 to 2012. Ann Vasc Surg. 2017;42:111-119. doi: 10.1016/j.avsg.2017.01.007 [PMID: 28359796]
  5. Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol. 2017;31:15-25. doi: 10.1016/j.bpg.2016.10.018 [PMID: 28395784]
  6. Vartanoglu Aktokmakyan T, Tokocin M, Meric S, Celebi F. Is mesenteric ischemia in covid-19 patients a surprise? Surg Innov. 2021;28:236-238. doi: 10.1177/1553350620962892 [PMID: 32996834]
  7. Ignat M, Philouze G, Aussenac-Belle L, Faucher V, Collange O, Mutter D, et al. Small bowel ischemia and SARS-CoV-2 infection: an underdiagnosed distinct clinical entity. Surgery. 2020;168:14-16. doi: 10.1016/j.surg.2020.04.035 [PMID: 32473831]
  8. Al Mahruqi G, Stephen E, Abdelhedy I, Al Wahaibi K. Our early experience with mesenteric ischemia in COVID-19 positive patients. Ann Vasc Surg. 2021; 73:129-132. doi: 10.1016/j.avsg.2021.01.064 [PMID: 33508450]
  9. Sehhat S, Talebzadeh H, Hakamifard A, Melali H, Shabib S, Rahmati A, et al. Acute mesenteric ischemia in a patient with covid-19: a case report. Arch Iran Med. 2020;23:639-643. doi: 10.34172/aim.2020.77 [PMID: 32979913]
  10. Azouz E, Yang S, Monnier-Cholley L, Arrivé L. Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19. Intensive Care Med. 2020;46:1464-1465. doi: 10.1007/s00134-020-06079-2 [PMID: 32424482]
  11. Cheung S, Quiwa JC, Pillai A, Onwu C, Tharayil ZJ, Gupta R. Superior mesenteric artery thrombosis and acute intestinal ischemia as a consequence of covid-19 infection. Am J Case Rep. 2020;21:e925753. doi: 10.12659/AJCR.925753 [PMID: 32724028]
  12. Azhdeh S, Mohammadi-Vajari M-A, Khaleghi M. Mesenteric Ischemia in a Case of COVID-19. CRCP. 5:11-14. doi: 10.18502/crcp.v5iS1.6237
  13. Kielty J, Duggan WP, O'Dwyer M. Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2. Ann R Coll Surg Engl. 2020 ;102:e145-e147. doi: 10.1308/rcsann.2020.0145 [PMID: 32538098]
  14. Mitchell JM, Rakheja D, Gopal P. SARS-CoV-2-related hypercoagulable state leading to ischemic enteritis secondary to superior mesenteric artery thrombosis. Clin Gastroenterol Hepatol. 2020;19(11):e111. doi: 10.1016/j.cgh.2020.06.024 [PMID: 32562891]
  15. A Beccara L, Pacioni C, Ponton S, Francavilla S, Cuzzoli A. Arterial mesenteric thrombosis as a complication of sars-cov-2 infection. Eur J Case Rep Intern Med. 2020;7:001690. doi: 10.12890/2020_001690 [PMID: 32399456]
  16. Vulliamy P, Jacob S, Davenport RA. Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19. Br J Haematol. 2020;189:1053-1054. doi: 10.1111/bjh.16760 [PMID: 32353183]
  17. de Barry O, Mekki A, Diffre C, Seror M, El Hajjam M, Carlier RY. Arterial and venous abdominal thrombosis in a 79-year-old woman with COVID-19 pneumonia. Radiol Case Rep. 2020;15:1054-1057. doi: 10.1016/j.radcr.2020.04.055 [PMID: 32351657]
  18. Khesrani LS, Chana K, Sadar FZ, Dahdouh A, Ladjadj Y, Bouguermouh D. Intestinal ischemia secondary to COVID-19. J Pediatr Surg Case Rep. 2020;61:101604. doi: 10.1016/j.epsc.2020.101604 [PMID: 32839689]
  19. Norsa L, Valle C, Morotti D, Bonaffini PA, Indriolo A, Sonzogni A. Intestinal ischemia in the COVID-19 era. Dig Liver Dis. 2020;52:1090-1091. doi: 10.1016/j.dld.2020.05.030 [PMID: 32532607]
  20. Singh B, Mechineni A, Kaur P, Ajdir N, Maroules M, Shamoon F, et al. Acute Intestinal Ischemia in a Patient with COVID-19 Infection. Korean J Gastroenterol. 2020;76:164-166. doi: 10.4166/kjg.2020.76.3.164 [PMID: 32969365]
  21. English W, Banerjee S. Coagulopathy and mesenteric ischaemia in severe SARS-CoV-2 infection. ANZ J Surg. 2020;90:1826. doi: 10.1111/ans.16151 [PMID: 32621375]
  22. Krothapalli N, Jacob J. A rare case of acute mesenteric ischemia in the setting of covid-19 infection. Cureus. 2021;13:e14174. doi: 10.7759/cureus.14174 [PMID: 33936885]
  23. Soeselo DA, Hambali W, Theresia S. Bowel necrosis in patient with severe case of COVID-19: a case report. BMC Surg. 2021;21(1):97. doi: 10.1186/s12893-021-01104-7 [PMID: 33618677]
  24. Hanif M, Ahmad Z, Khan AW, Naz S, Sundas F. COVID-19-induced mesenteric thrombosis. Cureus. 2021;13:e12953. doi: 10.7759/cureus.12953 [PMID: 33654625]
  25. Bagheripour MH, Zakeri MA. Acute mesenteric ischemia in a covid-19 patient: delay in referral and recommendation for surgery. Case Rep Gastrointest Med. 2021;2021:1999931. doi: 10.1155/2021/1999931 [PMID: 34777882]
  26. Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H. Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterol. 2007;7:34. doi: 10.1186/1471-230X-7-34 [PMID: 17697371]
  27. Eltarawy IG, Etman YM, Zenati M, Simmons RL, Rosengart MR. Acute mesenteric ischemia: the importance of early surgical consultation. Am Surg. 2009;75(3):212-9. [PMID: 19350855]
  28. Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med. 2020;382(17):e38.           doi: 10.1056/NEJMc2007575 [PMID: 32268022]
  29. Pan XW, Xu D, Zhang H, Zhou W, Wang LH, Cui XG. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46:1114-1116. doi: 10.1007/s00134-020-06026-1 [PMID: 32236644]
  30. Escher R, Breakey N, Lämmle B. Severe COVID-19 infection associated with endothelial activation. Thromb Res. 2020;190:62. doi: 10.1016/j.thromres.2020.04.014 [PMID: 32305740]
  31. Levi M, van der Poll T, Büller HR. Bidirectional relation between inflammation and coagulation. Circulation. 2004;109(22):2698-704. doi: 10.1161/01.CIR.0000131660.51520.9A [PMID: 15184294]
  32. Chiu YW, Wu CS, Chen PC, Wei YC, Hsu LY, Wang SH. Risk of acute mesenteric ischemia in patients with diabetes: A population-based cohort study in Taiwan. Atherosclerosis. 2020 ;296:18-24. doi: 10.1016/j.atherosclerosis.2020.01.016 [PMID: 32005001]
  33. Safavi-Naeini P, Rasekh A. Thromboembolism in Atrial Fibrillation: Role of the Left Atrial Appendage. Card Electrophysiol Clin. 2020;12:13-20. doi: 10.1016/j.ccep.2019.11.003 [PMID: 32067643]
  34. Sise MJ. Mesenteric ischemia: the whole spectrum. Scand J Surg. 2010;99:106-10. doi: 10.1177/145749691009900212 [PMID: 20679047]