Isquemia mesentérica segmentaria como secuela de la COVID-19: Informe de un caso / Segmental mesenteric ischemia as a sequel to COVID-19: A case report

Coronaviruses can cause respiratory, gastrointestinal, and central nervous system diseases in humans and animals, have the ability to adapt through mutations, and are programmed to modify host tropism. SARS-CoV-2 infection (COVID-19) has been shown to be a highly thrombogenic disease, generating deep vein thrombosis, pulmonary embolism and acute ischemia, in patients even without previous pathology. Coronaviruses can cross the species barrier and infect humans with unexpected consequences for public health. The transmission rate of SARS-CoV-2 is higher compared to that of closely related SARS-CoV infections. Key residues of the spike protein have a higher binding affinity for ACE2. These may be the reason for the higher transmission rate of SARS-CoV-2. COVID-19 has been shown in some patients to be a highly thrombogenic disease, both venous and arterial, generating deep vein thrombosis, pulmonary embolism and acute ischemia, both in patients without previous pathology as with them.There is molecular evidence of the state of hyper coagulability in COVID-19; the first observations were made by Wang, in 2020, when analyzing the levels of fibrinogen and D-dimer in patients with COVID-19 and finding elevated levels up to 75% above the laboratory controls. We present the case of a 62-year-old male with mild symptoms of COVID-19 and outpatient management, at the end of the clinical disease he presented an acute abdomen secondary to mesenteric ischemia, with good postoperative evolution.

Los coronavirus pueden causar enfermedades respiratorias, gastrointestinales y del sistema nervioso central en seres humanos y animales; tienen la capacidad para adaptarse por medio de mutaciones y son programados para modificar el tropismo del huésped. La infección por el SARS-CoV-2 (COVID-19) genera trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, en pacientes sin afección previa. Los coronavirus infectan a los seres humanos con consecuencias inesperadas para la salud pública. La tasa de transmisión de la infección por el SARS-CoV-2 es más alta en comparación con las infecciones por SARS-CoV estrechamente relacionadas. Los residuos clave de la proteína espiga tienen mayor afinidad de unión por el receptor de la enzima convertidora de angiotensina (ECA2). Esta puede ser la razón de la mayor tasa de transmisión de SARS-CoV-2. La COVID-19 ha demostrado, en algunos pacientes, ser una enfermedad altamente trombogénica, tanto venosa como arterial, dado que genera trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, tanto en pacientes sin afecciones previas como con ellas. Existe evidencia molecular del estado de hipercoagulabilidad en la COVID-19; las primeras observaciones fueron realizadas por Wang en 2020, al analizar los niveles de fibrinógeno y dímero-D en pacientes con COVID-19, y encontrar niveles elevados hasta 75% por arriba de los controles de laboratorio. Se presenta el caso de un paciente masculino de 62 años, con un cuadro leve de COVID-19 y abordaje ambulatorio; al término de la enfermedad clínica presentó abdomen agudo secundario a isquemia mesentérica, con buena evolución en el posoperatorio.

Post-Ischemic Bowel Stricture: CT Features in Eight Cases

OBJECTIVE: To investigate the characteristic radiologic features of post-ischemic stricture, which can then be implemented to differentiate that specific disease from other similar bowel diseases, with an emphasis on computed tomography (CT) features. MATERIALS AND METHODS: Eight patients with a diagnosis of ischemic bowel disease, who were also diagnosed with post-ischemic stricture on the basis of clinical or pathologic findings, were included. Detailed clinical data was collected from the available electronic medical records. Two radiologists retrospectively reviewed all CT images. Pathologic findings were also analyzed. RESULTS: The mean interval between the diagnosis of ischemic bowel disease and stricture formation was 57 days. The severity of ischemic bowel disease was variable. Most post-ischemic strictures developed in the ileum (n = 5), followed by the colon (n = 2) and then the jejunum (n = 1). All colonic strictures developed in the “watershed zone.” The pathologic features of post-ischemic stricture were deep ulceration, submucosal/subserosal fibrosis and chronic transmural inflammation. The mean length of the post-ischemic stricture was 7.4 cm. All patients in this study possessed one single stricture. On contrast-enhanced CT, most strictures possessed concentric wall thickening (87.5%), with moderate enhancement (87.5%), mucosal enhancement (50%), or higher enhancement in portal phase than arterial phase (66.7%). CONCLUSION: Post-ischemic strictures develop in the ileum, jejunum and colon after an interval of several weeks. In the colonic segment, strictures mainly occur in the “watershed zone.” Typical CT findings include a single area of concentric wall thickening of medium length (mean, 7.4 cm), with moderate and higher enhancement in portal phase and vasa recta prominence.

Paroxysmal Nocturnal Hemoglobinuria Presenting as Recurrent Jejunitis / 대한내과학회지

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematopoietic stem cell disorder characterized by chronic complement-mediated intravascular hemolysis, nocturnal hemoglobinuria, predisposition to thrombosis and secondary bone marrow failure. Small bowel ischemia is a complication of PNH but has not been reported to date in a Korean adult. We report here a case of PNH presenting as recurrent jejunitis. Despite the uncommon etiology, PNH should be considered in the differential diagnosis of patients with unexplained recurrent jejunitis.

Diffuse Colonic Infarction due to Multiple Mesenteric Embolism

Acute mesenteric ischemia and infarction is emergent situation associated with high mortality, arising from sudden loss of blood supply to mesenteric vessels. Most of all, the patients has cardiovascular insufficiency such as arrhythmia, recent myocardial infarction or valvular heart diseases. Acute abdominal pain is a main symptom and abdominal distension, rigidity, nausea and/or vomiting, and diarrhea are frequently observed. Delayed diagnosis and management are usually due to the nonspecific symptom and sign and lack of accurate diagnostic modality. A patient with acute abdominal pain having a history of cardiovascular disorders should be meticulously evaluated considering to exclude mesenteric vascular emergency. This dismal disease is mostly segmental ischemia of small bowel or colon due to occlusion of one mesenteric vessel, but occasionally multiple occlusions is are possible. We report a 67 years old female patient with diffuse colonic infarction due to multiple mesenteric embolism with review of literatures.

Bowel Ischemia by Blunt Abdominal Trauma / 대한소화기내시경학회지

The intestine is the third most commonly injured abdominal organ in blunt trauma. But we had a paucity of experience with these injuries. We experienced bowel ischemia in 55 year-old woman after motor-vehicle accident. She complained nausea, vomiting and weight, loss after traffic accident. We found mucosal hyperemia and intraluminal stenosis of duodenal second portion by the gastroscopy. So, we performed hypotonic duodenography and SMA and celiac angiograpby. Hypotonie duodenography showed a luminal narrowing from duodenojejunal junction to proximal jejunum and proximal dilatation, and SMA angiography showed 10 cm segment hypervascular staining of contrast medium in proximal portion. Therefore we performed jejunal loop segmentectomy. After operation she was discharged without complication.