ABSTRACT
BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) commonly present with fever, constitutional symptoms, and respiratory symptoms. However, atypical presentations are also well known. Though isolated mesenteric arterial occlusion associated with COVID-19 has been reported in literature, combined superior mesenteric arterial and venous thrombosis is rare. We report a case of combined superior mesenteric arterial and venous occlusion associated with COVID-19 infection. CASE REPORT: We report a case of a 45-year-old man who was a health care worker who presented to the emergency department with severe abdominal pain. The clinical examination was unremarkable, but imaging revealed acute mesenteric ischemia caused by superior mesenteric artery and superior mesenteric vein occlusion. Imaging of the chest was suggestive of COVID-19 infection, which was later confirmed with reverse transcription polymerase chain reaction of his nasopharyngeal swab. To date, only 1 case of combined superior mesenteric artery and superior mesenteric vein thrombosis caused by COVID-19 has been reported. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: During the COVID-19 pandemic it is important to keep mesenteric ischemia in the differential diagnosis of unexplained abdominal pain. Routinely adding high-resolution computed tomography of the chest to abdominal imaging should be considered in patients with acute abdomen because it can help to identify COVID-19 immediately. © 2020 Elsevier Inc.
Subject(s)
COVID-19/complications , COVID-19/diagnosis , Intestines/blood supply , SARS-CoV-2/isolation & purification , Thrombosis/virology , Venous Thrombosis/diagnostic imaging , Abdominal Pain/etiology , COVID-19 Nucleic Acid Testing/methods , Female , Humans , Intestines/diagnostic imaging , Intestines/surgery , Laparotomy , Male , Mesenteric Arteries , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/surgery , Mesenteric Ischemia , Mesenteric Vascular Occlusion/diagnosis , Mesenteric Vascular Occlusion/diagnostic imaging , Mesenteric Vascular Occlusion/etiology , Mesenteric Vascular Occlusion/surgery , Mesenteric Veins , Middle Aged , Nasopharynx/virology , Pandemics , Radiography, Thoracic/methods , Real-Time Polymerase Chain Reaction/methods , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Tomography, X-Ray Computed , Treatment Outcome , Venous Thrombosis/complications , Venous Thrombosis/diagnosis , Venous Thrombosis/etiologyABSTRACT
BACKGROUND: There is increasing evidence supporting coronavirus disease 2019 (COVID-19)-related coagulopathy. In the available literature, only 2 cases of superior mesenteric vein thrombosis have been described. METHODS: We present a peculiar case of high-grade small bowel obstruction in a patient with COVID-19 infection. RESULTS: Exploratory laparotomy revealed a congenital adhesion band with associated focal bowel ischemia contributed by superior mesenteric vein thrombosis and positive lupus anticoagulant. CONCLUSIONS: It is important to consider the rare differential of mesenteric vein thrombosis and its related sequelae of mesenteric ischemia in a patient with COVID-19 who presents with abdominal pain.