ABSTRACT
Acute Mesenteric Ischemia (AMI) is a life-threatening complication that
may occur in COVID-19 patients. It should be suspected in COVID-19
patients complaining of severe abdominal pain. This report highlights a
case of AMI with patent mesenteric vessels in CECT, and the importance
of monitoring hospitalized patients along with thromboembolism
prophylaxis.
INTRODUCTION
The ongoing coronavirus disease-2019 (COVID-19) pandemic has entered its
third year, with over 418 million cumulative cases as of Feb 2022
[1]. COVID-19 is caused by Severe Acute Respiratory Syndrome-Corona
Virus-2 (SARS‐CoV‐2) which can present as asymptomatic infection to
severe acute respiratory distress syndrome (ARDS) [2]. Although
COVID-19 mostly affects the respiratory system, it can also present with
extrapulmonary manifestations [3,4]. These conditions include
thrombotic complications, myocardial dysfunction and arrhythmia, acute
coronary syndromes, acute kidney injury, gastrointestinal symptoms,
hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses,
ocular symptoms, and dermatologic complications [3].
COVID-19 is known to induce a hypercoagulable state leading to both
micro- and macrovascular thrombosis, which affects both the venous and
arterial system [5]. However, arterial occlusion of the mesentery in
the context of COVID-19 has only been reported by few articles. Acute
mesenteric ischemia (AMI) has been defined as “a sudden onset of small
intestinal hypoperfusion, which can be due to occlusive or nonocclusive
obstruction of the arterial blood supply or obstruction of venous
outflow” [6]. The incidence of AMI in critically ill COVID-19
patients has been reported ranging from 3.8 to 4% [7,8]. The
overall mortality in COVID-19 patients with gastrointestinal (GI)
ischemia was 38%[9].
Here we present a case of AMI in a COVID-19 patient. To our knowledge,
this is the first case reported from Nepal. We report this case in line
with the updated consensus-based surgical case report (SCARE) guidelines
[10].