Abstract

The coronavirus disease 2019 (COVID-19) may have multisystem organ involvement. Thrombotic events are well-recognized complications of COVID-19. Such complications may include the pulmonary, renal, and other organs vasculature. The risk of coagulopathy is usually related to the severity of COVID-19 pneumonia. Few cases suggested that the coagulopathy risk may persist for some period after the recovery from COVID-19. We report the case of a middle-aged man with severe COVID-19 pneumonia that required seven days of endotracheal intubation and mechanical ventilation who presented with headache and left-sided weakness that occurred three days after his discharge. A computed tomography scan was performed to rule out intracranial hemorrhage before initiating the thrombolytic therapy. The scan demonstrated hemorrhage in the right temporal lobe with surrounding vasogenic edema along with density in the right transverse sinus. Subsequently, computed tomography venography was performed and demonstrated the filling defect representing right sigmoid venous sinus thrombosis. The patient received conservative measures in the form of intravenous hydration, anticoagulation, analgesics, and anticonvulsants. During the hospital stay, the patient had improvement in his symptom and mild neurological deficit persisted. The case highlighted that risk of thrombotic complications in COVID-19 pneumonia may persist for some period after the recovery from the disease. Hence, thromboprophylaxis may be indicated in selected patients with a risk of thrombotic events after their recovery from severe COVID-19.

Small intestinal obstruction is a common indication for hospitalization and emergency surgeries. The most frequent etiologies are adhesions, hernia, and benign or malignant neoplasms. Abdominal imaging plays an important role in making the diagnosis and evaluating the complications of the obstruction. We report a case of a young woman who presented with sudden abdominal pain and vomiting. She had a relevant past medical history of sickle cell disease and multiple episodes of biliary colic for which she underwent laparoscopic cholecystectomy two months before her current presentation. Laboratory findings indicated mild inflammation in the form of elevated C-reactive protein and erythrocyte sedimentation rate with the leukocytes count in the upper normal limits. Abdominal computed tomography demonstrated a knuckle of small bowel incarcerated in the port location of the previous laparoscopy. The bowel was reduced and the defect was repaired. The patient had complete resolution of her symptoms following the surgery. The case highlighted the importance of considering port-site hernia as an etiology of bowel obstruction in the relevant clinical settings since laparoscopic operations are being increasingly performed.