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].