COVID-19-Induced Mesenteric Thrombosis

Hanif, Muhammad; Ahmad, Zeeshan; Khan, Abdul Wali; Naz, Sidra; Sundas, Fnu

doi:10.7759/cureus.12953

Cited by 13 publications

(22 citation statements)

References 8 publications

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“…We also identified 30 case reports or case series [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] presenting 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings. 8 cases were previously hospitalized for COVID-19 pneumonia and under anticoagulant medication ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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“…This coagulopathy has been proposed to be due to complement-mediated microvascular injury, immune dysregulation, antiphospholipid syndrome-like state, and vascular imaging abnormalities [4,5]. In COVID-19-associated intestinal ischemia, bowel gangrene has been reported to occur with or without the involvement of the major arteries such as superior mesenteric artery or veins such as superior mesenteric vein and portal vein [8][9][10][11]. In the index case, the large-sized arteries were patent with no apparent atherosclerotic disease.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, COVID-19 is associated with coagulopathy and vasculitis, which correlate with the disease severity and increase the risk of mortality [3][4][5][6][7]. Involvement of the mesenteric vessels in COVID-19 patients can predispose to the development of intestinal ischemia [8][9][10][11]. Due to predominant respiratory manifestations, the gastrointestinal manifestations of COVID-19 are often overlooked, leading to delayed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Colonic Gangrene: A Sequela of Coronavirus Disease 2019

Varshney¹,

Bansal²,

Khanduri³

et al. 2021

Cureus

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Initially considered to be a respiratory disease, coronavirus disease 2019 (COVID-19) is now recognized as a multisystem disease known to affect all the major organs, including the gastrointestinal system. Based on recent studies, severe acute respiratory syndrome coronavirus 2 causes dysregulation of multiple biological pathways, triggers an exaggerated immune response, and affects multiple organs. The gastrointestinal symptoms in COVID-19 are common but often overlooked. We report the case of a 50-year-old female with a recent history of COVID-19 presenting with complaints of abdominal pain and constipation. Initially, the patient was treated for respiratory symptoms and discharged home. Subsequently, she was re-admitted and diagnosed with colonic obstruction on radiology. Laparotomy revealed descending and sigmoid colonic gangrene requiring left colectomy. This case highlights the uncommon but severe gastrointestinal manifestations of COVID-19.

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“…Male gender, hypertension, obesity, cardiovascular disease, and prolonged immobilization are the main risk factors for thrombotic complications [ 8 ]. There is an increasing number of cases being reported in patients with no contributing risk factors or comorbidities [ 9 ]. Coagulopathy affects the micro-vascular beds like the pulmonary, renal, and hepatic systems, leading to end-organ damage, and the macrovascular large vessels, leading to deep vein thrombosis (DVT), stroke, myocardial infarction, lower limb ischemia, and mesenteric ischemia [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another possible contributing factor for thromboembolism in COVID-19 patients may be the hypoxia associated with severe COVID-19. Hypoxia stimulates thrombosis by increasing the blood viscosity and hypoxia-inducible transcription factor signaling pathway [ 9 , 11 ]. Along with the endothelial injury and hypercoagulability described above, stasis is often seen in critically ill COVID-19 patients because of prolonged bed rest and immobilization in the critical care unit.…”

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia as an Early Complication of COVID-19

Sevella¹,

Rallabhandi²,

Jahagirdar³

et al. 2021

Cureus

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We herein report a case of a 44-year old male patient with coronavirus disease 2019 (COVID-19) who presented with acute mesenteric ischemia. Acute mesenteric ischemia presents with severe abdominal pain, vomiting, and constipation. The case consisted of features typical of acute mesenteric ischemia. The patient underwent laparotomy with resection of a gangrenous segment of the bowel. The radiological features of the injury along with the pathophysiology and management have been discussed.

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COVID-19-Induced Mesenteric Thrombosis

Cited by 13 publications

References 8 publications

Acute Mesenteric Ischemia in COVID-19 Patients

Acute Mesenteric Ischemia in COVID-19 Patients

Colonic Gangrene: A Sequela of Coronavirus Disease 2019

Acute Mesenteric Ischemia as an Early Complication of COVID-19

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