Acute Mesenteric Ischemia in a COVID-19 Patient: Delay in Referral and Recommendation for Surgery

Abstract

Coronavirus (COVID-19) is more common with symptoms such as fever, dry cough, and shortness of breath. However, it may be associated with COVID-19-induced gastrointestinal (GI) symptoms including acute mesenteric ischemia (AMI). These conditions make the diagnosis of AMI challenging. Timely referral with correct diagnosis and attention to the uncommon symptoms of COVID-19 can play an important role in the management and treatment of AMI in COVID-19 patients. We present a patient with AMI due to thrombotic complications of COVID-19, who referred to the hospital too late and ignored the recommendation for abdominal surgery.

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

“…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 .…”

“…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 .…”

“…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 , …”

“…In an Iranian case series of 24 patients, the median age was 61.5 years and 67% of them were male 53 . Peripheral and bilateral consolidations and groundglass opacities were the most common pulmonary findings 8,9,20,25,26,28,31,32,[34][35][36][37][38][39][40][41][43][44][45][46][47][48][49]53,59,61 . 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 .…”

Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study

“…Recent studies have evaluated the effect of COVID-19 pandemic healthcare delays on the diagnosis and treatment of a wide range of health problems, including cardiovascular disease [14][15][16][17][18][19][20][21] and cancer , with several studies focused on Emergency Department (ED), obstetrics, gynecology and pediatric patients [37,[46][47][48][49][50][51][52][53] and a limited number of studies focused on surgical procedures [20,29,41,[54][55][56][57][58][59][60][61][62][63][64]. To date, few studies have attempted to examine predictors of delayed surgical or non-surgical healthcare services in the general population [65,66].…”