Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report

Asghari, Akram; Adeli, Seyed Hasan; Vafaeimanesh, Jamshid; Bagheri, Hamed; Riahi, Mohammad Mahdi; Mirdamadi, Mahsa

doi:10.34172/mejdd.2021.208

Cited by 6 publications

(14 citation statements)

References 18 publications

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“…Only four reports did not mention the diagnostic method 28 , 52 , 57 , 62 and there was detection of viral RNA in the intestinal mucosa of a patient through the In Situ Hybridization technique, performed due to the high clinical suspicion associated with a previously negative PCR and absence of inflammatory patterns characteristic of COVID-19 on their chest CT 23 . Fever, cough, and dyspnea were the most reported symptoms 7 , 10 , 20 , 24 , 27 , 28 , 30 - 33 , 37 - 39 , 41 , 47 , 48 , 51 , 53 , 54 , 57 - 61 .…”

Section: Resultsmentioning

confidence: 99%

“…In the studies that cited the gastrointestinal clinical manifestations, the most frequent was abdominal pain with or without other complaints ( Table 1 ), being characterized as intense 7 , 8 , 20 , 24 , 25 , 30 , 31 , 38 , 39 , 41 , 43 , 44 , 51 , 62 , of sudden onset 8 , 31 , 35 , 36 , 38 - 40 , 47 , 58 , 59 , in cramps and without clear triggering factor 34 , 49 , 51 , of diffuse location 8 , 9 , 20 , 28 , 38 , 40 , 41 , 45 , 60 , and epigastric and/or mesogastric 25 - 27 , 49 , 51 .…”

Section: Resultsmentioning

confidence: 99%

“…The positive patients for COVID-19 in the study by Aktokmakyan et al who arrived at the emergency room receiving a preliminary diagnosis of acute abdomen were subsequently operated on due to mesenteric ischemia 54 . In addition to these, another group resorted to the emergency for gastrointestinal symptoms, with or without the presence of associated respiratory symptoms; in these cases, pneumonia was confirmed after admission 23 , 25 , 27 , 32 , 34 , 35 , 38 , 40 , 41 , 46 , 51 . One patient was admitted for ischemic stroke due to occlusion of the right middle cerebral artery, COVID-19 being confirmed by PCR after suggestive findings in imaging tests and, two days after admission, he developed abdominal pain and vomiting 50 .…”

Section: Resultsmentioning

confidence: 99%

“…The noticed laboratory abnormalities were leukocytosis 7 - 9 , 20 , 23 , 24 , 27 , 28 , 32 , 36 - 38 , 40 , 41 , 43 - 45 , 48 , 49 , 51 , 53 , 57 - 59 , 61 , elevated or close to the maximum reference values of C-reactive protein (CRP) 9, 10,20,23,24,27,38,41,43,44,46,48,51,53,54,57-59,61 , procalcitonin 7 , 9 , 10 , 57 , lactate dehydrogenase (LDH) 24 , 32 , 37 , 41 , 49 , 53 , 57 , 59 , 61 , ferritin 10 , 25 , 28 , 33 , 44 , 49 , 51 , fibrinogen 26 , 28 , 33 , 34 , 54 , 55 , 57 , 60 and D-dimer 7 , 10 , 23 , 25 - 28 , 31 , 33 , 34 , 36 - 38 , 40 , 46 , 49 , …”

Section: Resultsmentioning

confidence: 99%

“…Another patient was treated clinically. 62.5% mortality Hanif et al 61 Pakistan 1 20 Abdominal pain, tenderness, and distention Various levels of fluids Laparotomy with resection of gangrenous bowel Discharge Asghari et al 41 Iran 1 51 Abdominal pain, tenderness and distention, nausea Dilation of bowel loops Emergency laparotomy on 1 st admission, 2 relaparotomies on 2 nd admission, with resection of necrotic bowel Death Gupta et al 62 India 1 55 Abdominal pain, vomiting SMA Thrombosis Laparotomy with resection of the gangrenous bowel Death Hussein et al 43 Saudi Arabia 1 20 Abdominal pain, hematochezia Mesenteric, portal, splenic, and right hepatic venous thrombosis, intestinal congestion, ascites, pneumatosis, and pneumoperitoneum At first, mechanical thrombectomy, thrombolytics and anticoagulation. Subsequently, laparotomy with resection of the necrotic intestine.…”

Section: Methodsmentioning

confidence: 99%

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Acute mesenteric ischemia and COVID-19: an integrative review of the literature

SILVA

Neto

2023

Rev. Col. Bras. Cir.

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Acute mesenteric ischemia and COVID-19: an integrative review of the literature

SILVA

Neto

2023

Rev. Col. Bras. Cir.

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Thrombosis leading to acute abdomen in corona virus disease- 19:A case series

Hashim

Khan

Areekkara

et al. 2022

Indian J Gastroenterol

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Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained.

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Morphine

2021

Reactions Weekly

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Lack of efficacy: case reportA 51-year-old man exhibited lack of efficacy during treatment with morphine for abdominal pain. The man presented to hospital with a 3-day history of abdominal pain. He reported worsening of pain with movement and change in position. Abdominal examination showed a distended abdomen that was severely tender to palpation. He was treated with unspecified IV fluids and ondansetron for nausea. The pain was refractory to morphine [morphine sulfate; route and dosage not stated], which necessitated multiple doses (lack of efficacy). Further analyses raised suspicions for COVID-19. Hence, he started receiving off-label treatment with hydroxychloroquine [hydroxychloroquine sulfate] 400mg single-dose, lopinavir/ritonavir 100/400mg twice daily for 5 days and ribavirin 1200mg twice daily for 5 days. He also received interferon-β. During ICU admission on day 3, sepsis phase was observed and subsequently, he underwent two laparotomies, resection and ileostomy. Pathological evaluation revealed intravascular thrombosis in mesenteric tissue with a necrotic margin. He tested positive for COVID-19. He was treated with heparin and unspecified broad-spectrum antibiotics. After 10 days of treatment in ICU, he was extubated and was haemodynamically stable; however, a decrease in the platelet count was noted. On the following day, he experienced GI bleeding [aetiology not specified]. The platelet count and creatinine level further decreased, and the heparin therapy was discontinued. However, he developed treatment-resistant sepsis and disseminated intravascular coagulation, and he passed away due to its complications.Asghari A, et al. Intestinal ischemia due to mesenteric vascular thrombosis in a patient with positive SARS-CoV-2 RNA without primary pulmonary symptom: A case report.

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Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report

Cited by 6 publications

References 18 publications

Acute mesenteric ischemia and COVID-19: an integrative review of the literature

Acute mesenteric ischemia and COVID-19: an integrative review of the literature

Thrombosis leading to acute abdomen in corona virus disease- 19:A case series

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