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Nakai T, Son D. Acute Mesenteric Ischemia Mimicking Severe COVID-19 Pneumonia: A Case Report on Diagnostic Challenges and Management. Cureus 2024; 16:e60466. [PMID: 38882959 PMCID: PMC11180220 DOI: 10.7759/cureus.60466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
This article demonstrates the need for abdominal imaging in COVID-19 patients with systemic symptoms in the differential diagnosis of acute mesenteric ischemia and critical COVID-19 pneumonia. We detail the case of a 91-year-old man, initially diagnosed with severe COVID-19 pneumonia, who was later found to have acute mesenteric ischemia through abdominal CT imaging, despite lacking typical abdominal symptoms. Abdominal CT revealed intramural and portal emphysema, leading to a diagnosis of acute mesenteric ischemia. Given the patient's advanced age and poor condition, supportive care was chosen, with the patient passing away 12 hours post-admission. This case highlights the critical need for comprehensive evaluation, including abdominal imaging, in COVID-19 patients with systemic symptoms to identify other serious conditions like acute mesenteric ischemia, especially in the absence of specific abdominal pain. Early detection is vital for appropriate management and improved patient outcomes.
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Affiliation(s)
- Tsubasa Nakai
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
- Department of General Medicine, Hino Hospital Association Hino Hospital, Hino-gun, JPN
| | - Daisuke Son
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
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Cai W, Zhao Y, Mallappa S. Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia. Viruses 2024; 16:506. [PMID: 38675849 PMCID: PMC11054494 DOI: 10.3390/v16040506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES COVID-19 infection confers an increased risk of coagulation dysfunction (1) predisposing to thromboembolism in many anatomical sites including the gastrointestinal tract (GIT) (2). This study investigates the clinical presentation and outcome in patients presenting with concurrent COVID-19 infection and gastrointestinal tract ischaemia. Furthermore, differentiation and comparisons are drawn between those with arterial and venous aetiology for mesenteric ischaemia. METHODS A systematic search was undertaken on EMBASE, PubMed, and MEDLINE. Two independent reviewers screened titles, abstracts, and full-text articles according to the inclusion criteria and extracted relevant data. Data analyses were conducted using Excel®. RESULTS Forty-one studies were included in the data analyses, yielding 44 patients. Twenty-six patients had mesenteric arterial occlusion, sixteen patients had mesenteric venous occlusion, and two patients had both arterial and venous mesenteric occlusion. All patients had concurrent COVID-19 infection. The survival rate in patients with arterial aetiology was 38.5% in contrast to 68.8% in patients with venous aetiology. Twelve patients (29.3%) experienced respiratory symptoms in the community before the onset of gastrointestinal symptoms, and five (12.2%) developed gastrointestinal symptoms during their inpatient stay for COVID-19 pneumonitis. CONCLUSIONS Acute mesenteric ischaemia presents a clinical challenge to diagnose due to its non-specific symptoms. Concurrent COVID-19 infection with its predominant respiratory symptoms adds a further challenge in recognising the non-specific symptoms of mesenteric ischaemia. Our study draws attention to the increased thromboembolic risk posed by COVID-19 infection and the need for a high index of suspicion to aid prompt diagnosis and management of acute mesenteric ischaemia, even in the post-pandemic era.
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Affiliation(s)
- Wenyi Cai
- East Suffolk and North Essex Foundation Trust, Colchester CO4 5JL, UK
- Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK
| | - Yi Zhao
- Imperial College London School of Medicine, London SW7 2DD, UK;
| | - Sreelakshmi Mallappa
- West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire WD18 0HB, UK;
- The Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
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Mallhi TH, Safdar A, Butt MH, Salman M, Nosheen S, Mustafa ZU, Khan FU, Khan YH. Atypical Complications during the Course of COVID-19: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:164. [PMID: 38256424 PMCID: PMC10819426 DOI: 10.3390/medicina60010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
COVID-19 is primarily a respiratory disease, but numerous studies have indicated the involvement of various organ systems during the course of illness. We conducted a comprehensive review of atypical complications of COVID-19 with their incidence range (IR) and their impact on hospitalization and mortality rates. We identified 97 studies, including 55 research articles and 42 case studies. We reviewed four major body organ systems for various types of atypical complications: (i) Gastro-intestinal (GI) and hepatobiliary system, e.g., bowel ischemia/infarction (IR: 1.49-83.87%), GI bleeding/hemorrhage (IR: 0.47-10.6%), hepatic ischemia (IR: 1.0-7.4%); (ii) Neurological system, e.g., acute ischemic stroke/cerebral venous sinus thrombosis/cerebral hemorrhage (IR: 0.5-90.9%), anosmia (IR: 4.9-79.6%), dysgeusia (IR: 2.8-83.38%), encephalopathy/encephalitis with or without fever and hypoxia (IR: 0.19-35.2%); (iii) Renal system, e.g., acute kidney injury (AKI)/acute renal failure (IR: 0.5-68.8%); (iv) Cardiovascular system, e.g., acute cardiac injury/non-coronary myocardial injury (IR: 7.2-55.56%), arrhythmia/ventricular tachycardia/ventricular fibrillation (IR: 5.9-16.7%), and coagulopathy/venous thromboembolism (IR: 19-34.4%). This review encourages and informs healthcare practitioners to keenly monitor COVID-19 survivors for these atypical complications in all major organ systems and not only treat the respiratory symptoms of patients. Post-COVID effects should be monitored, and follow-up of patients should be performed on a regular basis to check for long-term complications.
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Affiliation(s)
- Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Aqsa Safdar
- Faculty of Pharmaceutical Sciences, University of Central Punjab, Lahore 54000, Pakistan;
| | - Muhammad Hammad Butt
- Department of Medicinal Chemistry, Faculty of Pharmacy, Uppsala University, 75123 Uppsala, Sweden
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan;
| | - Sumbal Nosheen
- Department of Pharmacy, The Children’s Hospital and the University of Child Health Sciences, Lahore 54600, Pakistan;
| | - Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan;
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia;
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Silva JTC, Fonseca Neto OCLDA. Acute mesenteric ischemia and COVID-19: an integrative review of the literature. Rev Col Bras Cir 2023; 50:e20233334. [PMID: 36921130 PMCID: PMC10519703 DOI: 10.1590/0100-6991e-20233334-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/24/2022] [Indexed: 03/18/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was "mesenteric ischemia in patients with COVID-19: coincidence or association?". After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.
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SARS-COV-2-related superior mesenteric artery thrombosis resulting in pneumatosis intestinalis complicated by pneumatosis portalis in a young male: a case report. Ann Med Surg (Lond) 2023; 85:198-202. [PMID: 36845772 PMCID: PMC9949772 DOI: 10.1097/ms9.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/22/2022] [Indexed: 02/28/2023] Open
Abstract
The novel coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 is a highly contagious disease that has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been linked to damage other organ systems as well as coagulopathy. The features and clinical spectrum of COVID-19 are continually emerging, with growing evidence of its connection to thrombosis in various systems. In this case report, the authors present a case of COVID-19 infection in a young male patient who had superior mesenteric artery thrombosis with pneumatosis intestinalis complicated by hepatic portal venous gas.
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Gebran A, El Moheb M, Argandykov D, Mashbari H, Gartland RM, Hwabejire JO, Velmahos GC, Kaafarani HMA. Mesenteric Ischemia in Patients with Coronavirus 2019: A Scoping Review. Surg Infect (Larchmt) 2022; 23:781-786. [PMID: 36251963 DOI: 10.1089/sur.2022.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Coronavirus 2019 (COVID-19) is a systemic disease associated with severe gastrointestinal complications including life-threatening mesenteric ischemia. We sought to review and summarize the currently available literature on the presentation, management, and outcomes of mesenteric ischemia in patients with COVID-19. Patients and Methods: The PubMed database was searched to identify studies published between January 2020 and January 2021 that reported one or more adult (≥18 years) patients with COVID-19 who developed mesenteric ischemia during hospitalization. The demographic characteristics, clinical and imaging findings, management, and outcomes of patients from each study were extracted and summarized. Results: A total of 35 articles reporting on 61 patients with COVID-19 with mesenteric ischemia met the eligibility and were included in our study. The mean age was 60 (±15.9) years, and 53% of patients were male. Imaging findings of these patients included mesenteric arterial or venous thromboembolism, followed by signs of mesenteric ischemia. Sixty-seven percent of patients were taken to the operating room for an exploratory laparotomy and bowel resection and 21% were managed conservatively. The terminal ileum was the most commonly involved area of necrosis (26%). The mortality rate of patients with COVID-19 with mesenteric ischemia was 33%, and the most common cause of death was multiorgan failure or refractory septic shock. Twenty-seven percent of patients managed operatively died during the post-operative period. Conclusions: Mesenteric ischemia in patients with COVID-19 is a devastating complication associated with a high rate of morbidity and mortality. Further efforts should focus on developing strategies for early recognition and management.
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Affiliation(s)
- Anthony Gebran
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohamad El Moheb
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dias Argandykov
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hassan Mashbari
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Faculty of Medicine, Jazan University, Saudi Arabia
| | - Rajshri M Gartland
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John O Hwabejire
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George C Velmahos
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Gastrointestinal Ischemia—Stumbling Stone in COVID-19 Patients. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The emergence of the novel SARS-CoV2 virus, proclaimed by the World Health Organization (WHO) as a culpable agent for the pandemic situation, caught the scientific and medical communities off guard. One of the most common complications following pulmonary disease is represented by gastrointestinal (GI) disorders, especially ischemic damage. Inflammation, vasculopathy, immobility, endothelial dysfunction, and a hypercoagulable condition have all been proposed as pathophysiological factors for GI ischemia in these patients. Owing to the COVID-19 effect on a variety of GI conditions, especially ischemic changes, and the high mortality rate, physicians should always keep in mind this complication. They should take a deeper look at clinical and imaging modalities in this cohort of patients so that a proper and time-saving treatment strategy can be applied. Our study aimed to elucidate the thrombogenic mechanism in different GI disorders. Moreover, we analyzed the factors related to necrotic GI changes, by summarizing the already reported data of GI ischemia in COVID-19. To the best of our knowledge, this review is the first to incorporate all GI ischemia cases reported in the literature so far.
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Ojha V, Mani A, Mukherjee A, Kumar S, Jagia P. Mesenteric ischemia in patients with COVID-19: an updated systematic review of abdominal CT findings in 75 patients. Abdom Radiol (NY) 2022; 47:1565-1602. [PMID: 34761305 PMCID: PMC8580173 DOI: 10.1007/s00261-021-03337-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a less common but devastating complication of COVID-19 disease. The aim of this systematic review was to assess the most common CT imaging features of AMI in COVID-19 and also provide an updated review of the literature on symptoms, treatment, histopathological and operative findings, and follow-up of these patients. METHODS A systematic literature search of four databases: Pubmed, EMBASE, WHO database, and Google Scholar, was performed to identify all the articles which described abdominal CT imaging findings of AMI in COVID-19. RESULTS A total of 47 studies comprising 75 patients were included in the final review. Small bowel ischemia (46.67%) was the most prevalent abdominal CT finding, followed by ischemic colitis (37.3%). Non-occlusive mesenteric ischemia (NOMI; 67.9%) indicating microvascular involvement was the most common pattern of bowel involvement. Bowel wall thickening/edema (50.9%) was more common than bowel hypoperfusion (20.7%). While ileum and colon both were equally involved bowel segments (32.07% each), SMA (24.9%), SMV (14.3%), and the spleen (12.5%) were the most commonly involved artery, vein, and solid organ, respectively. 50% of the patients receiving conservative/medical management died, highlighting high mortality without surgery. Findings on laparotomy and histopathology corroborated strikingly with CT imaging findings. CONCLUSION In COVID-19 patients with AMI, small bowel ischemia is the most prevalent imaging diagnosis and NOMI is the most common pattern of bowel involvement. Contrast-enhanced CT is a powerful decision-making tool for prompt diagnosis of AMI in COVID-19, thereby potentially improving time to treat as well as clinical outcomes.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Avinash Mani
- Department of Cardiology, Sri Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Aprateem Mukherjee
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Gupta A, Sharma O, Srikanth K, Mishra R, Tandon A, Rajput D. Review of Mesenteric Ischemia in COVID-19 Patients. Indian J Surg 2022; 85:313-321. [PMID: 35309713 PMCID: PMC8916793 DOI: 10.1007/s12262-022-03364-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/05/2022] [Indexed: 12/11/2022] Open
Abstract
The new coronavirus (COVID-19) infection, first detected in Wuhan, China in 2019 has become a pandemic that has spread to nearly every country in the world. Through October 11, 2021, more than 23 billion confirmed cases and 4.8 million fatalities were reported globally. The bulk of individuals afflicted in India during the first wave were elderly persons. The second wave, however, resulted in more severe diseases and mortality in even younger age groups due to mutations in the wild virus. Symptoms may range from being asymptomatic to fatal acute respiratory distress syndrome (ARDS). In addition to respiratory symptoms, patients may present with gastrointestinal symptoms such as stomach pain, vomiting, loose stools, or mesenteric vein thrombosis. The frequency of patients presenting with thromboembolic symptoms has recently increased. According to certain studies, the prevalence of venous thromboembolism among hospitalized patients ranges from 9 to 25%. It was also shown that the incidence is significantly greater among critically sick patients, with a prevalence of 21–31%. Although the exact origin of thromboembolism is unknown, it is considered to be produced by several altered pathways that manifest as pulmonary embolism, myocardial infarction, stroke, limb gangrene, and acute mesenteric ischemia. Acute mesenteric ischemia (AMI) is becoming an increasingly prevalent cause of acute surgical abdomen in both intensive care unit (ICU) and emergency room (ER) patients. Mesenteric ischemia should be evaluated in situations with unexplained stomach discomfort. In suspected situations, appropriate imaging techniques and early intervention, either non-surgical or surgical, are necessary to avert mortality. The purpose of this article is to look at the data on acute mesenteric ischemia in people infected with COVID-19.
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Affiliation(s)
- Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Level 6, Medical College Block, Rishikesh, Uttarakhand 249203 India
| | - Oshin Sharma
- Department of Surgery, All India Institute of Medical Sciences, Level 6, Medical College Block, Rishikesh, Uttarakhand 249203 India
| | - Kandhala Srikanth
- Department of Surgery, All India Institute of Medical Sciences, Level 6, Medical College Block, Rishikesh, Uttarakhand 249203 India
| | - Rahul Mishra
- Department of Surgery, All India Institute of Medical Sciences, Level 6, Medical College Block, Rishikesh, Uttarakhand 249203 India
| | - Amoli Tandon
- Department of Surgery, All India Institute of Medical Sciences, Level 6, Medical College Block, Rishikesh, Uttarakhand 249203 India
| | - Deepak Rajput
- Department of Surgery, All India Institute of Medical Sciences, Level 6, Medical College Block, Rishikesh, Uttarakhand 249203 India
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Elboushi A, Syed A, Pasenidou K, Elmi L, Keen I, Heining C, Vasudev A, Tulmuntiha S, Karia K, Ramesh P, Pearce SR, Gao-Smith F, Veenith T, Nasr H, Sam R, Juszczak M. Arterial and venous thromboembolism in critically ill, COVID 19 positive patients admitted to Intensive Care Unit. Ann Vasc Surg 2022:S0890-5096(22)00065-6. [PMID: 35257911 PMCID: PMC8894740 DOI: 10.1016/j.avsg.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/12/2021] [Accepted: 02/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Amro Elboushi
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust; Vascular Surgery Department, Zagazig University Hospitals, Egypt.
| | - Arooj Syed
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Ketino Pasenidou
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Liban Elmi
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Irfan Keen
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Chris Heining
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Ashish Vasudev
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Sidra Tulmuntiha
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Kishan Karia
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Priyavarshini Ramesh
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Samuel R Pearce
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Fang Gao-Smith
- Institute Inflammation and Ageing, University of Birmingham; Department of Anaesthesia and Critical Care, University Hospitals Birmingham NHS Foundation Trust
| | - Tonny Veenith
- Institute Inflammation and Ageing, University of Birmingham; Department of Anaesthesia and Critical Care, University Hospitals Birmingham NHS Foundation Trust
| | - Hosaam Nasr
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Rachel Sam
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust
| | - Maciej Juszczak
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust; Institute Inflammation and Ageing, University of Birmingham
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Sukegawa M, Nishiwada S, Terai T, Kuge H, Koyama F, Nakagawa K, Nagai M, Sho M. Acute superior mesenteric artery occlusion associated with COVID-19 pneumonia: a case report. Surg Case Rep 2022; 8:6. [PMID: 35001200 PMCID: PMC8743238 DOI: 10.1186/s40792-022-01360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background The novel 2019 coronavirus disease (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2, has spread rapidly around the world and has caused many deaths. COVID-19 involves a systemic hypercoagulable state and arterial/venous thrombosis which induces unfavorable prognosis. Herein, we present a first case in East Asia where an acute superior mesenteric artery (SMA) occlusion associated with COVID-19 pneumonia was successfully treated by surgical intervention. Case presentation A 70-year-old man presented to his local physician with a 3-day history of cough and diarrhea. A real-time reverse transcriptase-polymerase chain reaction test showed positive for COVID-19, and he was admitted to the source hospital with the diagnosis of moderate COVID-19 pneumonia. Eight days later, acute onset of severe abdominal pain appeared with worsening respiratory condition. Contrast CT showed that bilateral lower lobe/middle lobe and lingula ground glass opacification with distribution suggestive of COVID-19 pneumonia and right renal infarction. In addition, it demonstrated SMA occlusion with intestinal ischemia suggesting extensive necrosis from the jejunum to the transverse colon. The patient underwent an emergency exploratory laparotomy with implementing institutional COVID-19 precaution guideline. Upon exploration, the intestine from jejunum at 100 cm from Treitz ligament to middle of transverse colon appeared necrotic. Necrotic bowel resection was performed with constructing jejunostomy and transverse colon mucous fistula. We performed second surgery to close the jejunostomy and transverse colon mucous fistula with end-to-end anastomosis on postoperative day 22. The postoperative course was uneventful and he moved to another hospital for rehabilitation to improve activities of daily living (ADLs) on postoperative day 45. As of 6 months after the surgery, his ADLs have completely improved and he has returned to social life without any intravenous nutritional supports. Conclusions Intensive treatment including surgical procedures allowed the patient with SMA occlusion in COVID-19 pneumonia to return to social life with completely independent ADLs. Although treatment for COVID-19 involves many challenges, including securing medical resources and controlling the spread of infection, when severe abdominal pain occurs in patients with COVID-19, physicians should consider SMA occlusion and treat promptly for life-saving from this deadly combination.
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Affiliation(s)
- Masahiro Sukegawa
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Taichi Terai
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroyuki Kuge
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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12
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Serban D, Tribus LC, Vancea G, Stoian AP, Dascalu AM, Suceveanu AI, Tanasescu C, Costea AC, Tudosie MS, Tudor C, Gangura GA, Duta L, Costea DO. Acute Mesenteric Ischemia in COVID-19 Patients. J Clin Med 2021; 11:200. [PMID: 35011941 PMCID: PMC8745985 DOI: 10.3390/jcm11010200] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 01/08/2023] Open
Abstract
Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms "COVID-19" and "bowel ischemia" OR "intestinal ischemia" OR "mesenteric ischemia" OR "mesenteric thrombosis". After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.
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Affiliation(s)
- Dragos Serban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.V.); (A.P.S.); (M.S.T.); (G.A.G.)
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.D.)
| | - Laura Carina Tribus
- Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Geta Vancea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.V.); (A.P.S.); (M.S.T.); (G.A.G.)
- “Victor Babes” Infectious and Tropical Disease Hospital Bucharest, 030303 Bucharest, Romania
| | - Anca Pantea Stoian
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.V.); (A.P.S.); (M.S.T.); (G.A.G.)
| | - Ana Maria Dascalu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.V.); (A.P.S.); (M.S.T.); (G.A.G.)
| | - Andra Iulia Suceveanu
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania; (A.I.S.); (D.O.C.)
| | - Ciprian Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | | | - Mihail Silviu Tudosie
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.V.); (A.P.S.); (M.S.T.); (G.A.G.)
| | - Corneliu Tudor
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.D.)
| | - Gabriel Andrei Gangura
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.V.); (A.P.S.); (M.S.T.); (G.A.G.)
- Second Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Lucian Duta
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (C.T.); (L.D.)
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania; (A.I.S.); (D.O.C.)
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
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13
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Chen C, Li YW, Shi PF, Qian SX. Acute Mesenteric Ischemia in Patients with COVID-19: Review of the literature. J Natl Med Assoc 2021; 114:47-55. [PMID: 34973847 PMCID: PMC8715336 DOI: 10.1016/j.jnma.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global health emergency. In addition to common respiratory symptoms, some patients with COVID-19 infections may experience a range of extra-pulmonary manifestations, such as digestive system involvement. Patients with COVID-19 have been reported to suffer from acute mesenteric ischemia (AMI) that is associated with disease-related severity and mortality. However, in the context of COVID-19, the exact cause of AMI has yet to be clearly defined. This review provides a comprehensive overview of the available data and elucidates the possible underlying mechanisms linking COVID-19 to AMI, in addition to highlighting therapeutic approaches for clinicians. Finally, given the severe global impact of COVID-19, we emphasize the importance of coordinated vaccination programs.
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Affiliation(s)
- Can Chen
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Yi-Wei Li
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Peng-Fei Shi
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Shen-Xian Qian
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China.
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14
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Alali AA, Baqais MO, Albishi FM, Alkhamis AI, Alshehri YA, Amri KF, Albenayan RF, Khudeer SA, Anbarserri MM, Alsharif MS, Hakami SM, Bahammam MA, Altooq NJ, Al-Hawaj F. Superior Mesenteric Artery Thrombosis Following Severe COVID-19 Pneumonia. Cureus 2021; 13:e19954. [PMID: 34976537 PMCID: PMC8713302 DOI: 10.7759/cureus.19954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/11/2022] Open
Abstract
Thrombotic events are well-recognized complications of coronavirus disease 2019 (COVID-19). The incidence of such complications is highly related to the severity of COVID-19 pneumonia. Recent evidence suggests that the coagulopathy of COVID-19 may persist for some period even after the full recovery from pneumonia. We report the case of a 35-year-old man who presented with a 10-day history of fever and cough. His plain radiograph showed bilateral peripherally located opacities suggestive of COVID-19. The diagnosis was confirmed by the reverse transcriptase-polymerase chain reaction (RT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was placed on a non-invasive ventilator but it failed to maintain normal oxygen saturation. Hence, the decision for intubation was made. He was extubated after 10 days in the ICU. The patient had a complete recovery. One week after discharge, the patient presented with severe abdominal pain that was out of proportion to the physical examination findings. He had an abdominal CT scan, which demonstrated a large thrombus occluding the superior mesenteric artery. There was no bowel dilatation or focal mural thickening to suggest bowel ischemia. The patient was resuscitated with intravenous fluid hydration. Opioid analgesics were administered to control the pain. After stabilizing the patient, he underwent laparotomy with thrombectomy. The patient tolerated the operation with no complications and had an uneventful recovery. The patient was discharged in good condition with no active issues after four days of hospitalization. The superior mesenteric thrombosis is an unusual complication of COVID-19 pneumonia. This case provides further evidence on the possibility of thrombotic events following the recovery from COVID-19. There is a pressing need for future studies to investigate the role of prophylactic antithrombotic and anticoagulants in patients who recovered from severe COVID-19.
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Affiliation(s)
| | | | | | | | | | | | - Rana F Albenayan
- Emergency Department, Primary Health Care Center Al-Awali, Al-Awali, SAU
| | - Shifa A Khudeer
- Emergency Department, Primary Health Care Center Al-Aziziyah, Al-Aziziyah, SAU
| | | | | | | | - Manar A Bahammam
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Noor J Altooq
- College of Medicine, Arabian Gulf University, Manama, BHR
| | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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15
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Sevella P, Rallabhandi SSH, Jahagirdar V, Kankanala SR, Ginnaram AR, Rama K. Acute Mesenteric Ischemia as an Early Complication of COVID-19. Cureus 2021; 13:e18082. [PMID: 34671542 PMCID: PMC8522848 DOI: 10.7759/cureus.18082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
We herein report a case of a 44-year old male patient with coronavirus disease 2019 (COVID-19) who presented with acute mesenteric ischemia. Acute mesenteric ischemia presents with severe abdominal pain, vomiting, and constipation. The case consisted of features typical of acute mesenteric ischemia. The patient underwent laparotomy with resection of a gangrenous segment of the bowel. The radiological features of the injury along with the pathophysiology and management have been discussed.
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Affiliation(s)
- Prerana Sevella
- Internal Medicine, Gandhi Hospital and Medical College, Secunderabad, IND
| | | | - Vinay Jahagirdar
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | | | | | - Kaanthi Rama
- Internal Medicine, Gandhi Hospital and Medical College, Hyderabad, IND
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16
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COVID-19 and Peripheral Artery Thrombosis: A Mini Review. Curr Probl Cardiol 2021; 47:100992. [PMID: 34571103 PMCID: PMC8462005 DOI: 10.1016/j.cpcardiol.2021.100992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
For more than 2 years, health care systems have been floundering in a massive crisis of coronavirus disease 2019 (COVID-19) pandemic. While acute respiratory distress syndrome is the main complication in patients with COVID-19, as the pandemic continues, more data about the nonrespiratory effects of the coronavirus is obtained, including developing Coagulopathy-related manifestations, in the form of venous and arterial thromboembolism. Although arterial thrombosis a rare complication of this disease, it proves to be an effective factor in the mortality and morbidity of COVID-19 patients. The pathophysiology of thrombosis reveals a complex relation between hemostasis and immune system that can be disrupted by COVID-19. Thrombectomy, anticoagulant therapy, and thrombolysis are the main treatments in these patients. In addition, appropriate thromboprophylaxis treatment should be considered in COVID-19 patients. In this article, we have successfully reviewed the arterial thrombotic events in patients reported around the world, including the diagnostic and management method of choice.
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17
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Pirola L, Palermo A, Mulinacci G, Ratti L, Fichera M, Invernizzi P, Viganò C, Massironi S. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg 2021; 13:702-716. [PMID: 34354803 PMCID: PMC8316849 DOI: 10.4240/wjgs.v13.i7.702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common. AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies. METHODS Bibliographical searches were performed in PubMed, using the following keywords: "COVID-19" AND "imaging" AND "gastrointestinal" OR "abdominal" OR "small bowel". RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman. CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.
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Affiliation(s)
- Lorena Pirola
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Giacomo Mulinacci
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Laura Ratti
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
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18
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Kerawala AA, Das B, Solangi A. Mesenteric ischemia in COVID-19 patients: A review of current literature. World J Clin Cases 2021; 9:4700-4708. [PMID: 34222436 PMCID: PMC8223851 DOI: 10.12998/wjcc.v9.i18.4700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/13/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) virus has affected all the systems of the body, defying all impressions of it being a respiratory virus only.
AIM To see the association of mesenteric ischemia with COVID-19.
METHODS After initial screening and filtering of the titles on PubMed and Google Scholar, 124 articles were selected. Articles were read in full, and the references were skimmed for relevance. Twenty-six articles (case reports and case series) were found to eligible for inclusion. References of these 26 articles were checked for any additional cases. Two more publications were found, and a total of 28 articles (22 case reports and 6 case series) have been included for review in this manuscript.
RESULTS A total of 41 cases of acute mesenteric ischemia in COVID-19 patients have been reported in the literature since the outbreak of this pandemic. Most of them include patients with comorbidities.
CONCLUSION In conclusion, based on this literature review and precise published knowledge regarding acute mesenteric ischemia in patients with COVID-19, it is essential to understand its relevance in all patients with gastrointestinal symptoms. The threshold for the diagnostic investigations should also be kept low for the timely diagnosis and management of this disorder.
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Affiliation(s)
- Asad Ali Kerawala
- Department of Surgery, Cancer Foundation Hospital, Karachi 75300, Pakistan
| | - Bhagwan Das
- Department of Medicine, Cancer Foundation Hospital, Karachi 75300, Pakistan
| | - Ahda Solangi
- New York Medical College, Valhalla, NY 10595, United States
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19
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Jain M, Tyagi R, Tyagi R, Jain G. Post-COVID-19 Gastrointestinal Invasive Mucormycosis. Indian J Surg 2021; 84:545-547. [PMID: 34177157 PMCID: PMC8219178 DOI: 10.1007/s12262-021-03007-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
Thrombo-embolic episodes and invasive mucormycosis (IM) have shown a sudden surge after the second wave of novel coronavirus infection in India. Acute mesenteric ischemia secondary to coronavirus-19 is rare and that too due to invasive mesenteric mucormycosis has not yet been reported in Indian literature. We present a case of post-COVID diabetic woman who was on steroids and had mesenteric thrombosis with IM. The disease is associated with high mortality. Treatment of choice is wide surgical resection and iv liposomal amphotericin B. Since the pre-operative as well as intra-operative diagnosis is difficult, high index of suspicion for IM is necessary in post-COVID-19 patients presenting with mesenteric ischemia or bowel perforation.
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Affiliation(s)
- Mayank Jain
- Department of GI and Minimal Access Surgery, Synergyplus Hospital, NH2, Near Guru Ka Taal, Agra, 282007 Uttar Pradesh India
| | - Ranvir Tyagi
- Department of Anesthesia and Critical Care Medicine, Synergyplus Hospital, NH2, Near Guru Ka Taal, Agra, 282007 Uttar Pradesh India
| | - Rakesh Tyagi
- Department of Anesthesia and Critical Care Medicine, Synergyplus Hospital, NH2, Near Guru Ka Taal, Agra, 282007 Uttar Pradesh India
| | - Gaurav Jain
- Department of Histopathology, National Reference Laboratory Dr LalPathlabs, Sector 18, Rohini, Delhi, 110085 India
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20
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Early Detection and Successful Management of Acute Mesenteric Ischaemia in Symptomatic COVID-19 Patient. Indian J Surg 2021; 84:209-211. [PMID: 33867749 PMCID: PMC8039803 DOI: 10.1007/s12262-021-02839-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/05/2021] [Indexed: 01/30/2023] Open
Abstract
Acute mesenteric ischaemia is a life-threatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. Its overall mortality is 60–80% and the reported incidence is increasing. This case report emphasises that a patient with early detection and radiological management of acute mesenteric ischaemia being symptomatic for COVID-19 can avoid major bowel surgery and negate any morbidity or mortality associated with the same.
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21
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Amaravathi U, Balamurugan N, Muthu Pillai V, Ayyan SM. Superior Mesenteric Arterial and Venous Thrombosis in COVID-19. J Emerg Med 2021; 60:e103-e107. [PMID: 33581991 PMCID: PMC7833911 DOI: 10.1016/j.jemermed.2020.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) commonly present with fever, constitutional symptoms, and respiratory symptoms. However, atypical presentations are also well known. Though isolated mesenteric arterial occlusion associated with COVID-19 has been reported in literature, combined superior mesenteric arterial and venous thrombosis is rare. We report a case of combined superior mesenteric arterial and venous occlusion associated with COVID-19 infection. Case Report We report a case of a 45-year-old man who was a health care worker who presented to the emergency department with severe abdominal pain. The clinical examination was unremarkable, but imaging revealed acute mesenteric ischemia caused by superior mesenteric artery and superior mesenteric vein occlusion. Imaging of the chest was suggestive of COVID-19 infection, which was later confirmed with reverse transcription polymerase chain reaction of his nasopharyngeal swab. To date, only 1 case of combined superior mesenteric artery and superior mesenteric vein thrombosis caused by COVID-19 has been reported. Why Should an Emergency Physician Be Aware of This? During the COVID-19 pandemic it is important to keep mesenteric ischemia in the differential diagnosis of unexplained abdominal pain. Routinely adding high-resolution computed tomography of the chest to abdominal imaging should be considered in patients with acute abdomen because it can help to identify COVID-19 immediately. © 2020 Elsevier Inc.
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Affiliation(s)
- Uthayakumar Amaravathi
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Nathan Balamurugan
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vivekanandan Muthu Pillai
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - S Manu Ayyan
- Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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