A Case of Intestinal Perforation Associated with Mesenteric Thrombosis Due to Post-COVID-19 Syndrome.

PURPOSE: We aimed to present a case who developed intestinal ischemia and associated perforation and abscess due to Superior Mesenteric Vein (SMV) thrombosis caused by post-COVID-19 syndrome and discuss the preoperative Computed Tomography (CT) imaging findings used in diagnosis. CASE PRESENTATION: A 58-year-old patient presented to our clinic with a complaint of acute abdominal pain. His CT examination revealed thrombosis in SMV, congestion in the mesenteric venous structures, contamination in the mesentery, and thickening and dilatation of the jejunal loops due to ischemia. The patient had a history of acute COVID-19 infection. He had typical COVID-19 pneumonia findings (peripheral ground-glass opacities in both lung parenchyma predominantly in the lower lobe) on the thorax CT at that time. He was followed up with anticoagulant therapy. During his follow-up, a thoracic and abdominal CT was performed due to recurrent acute abdominal findings. On thorax CT, there was a web-like filling defect consistent with pulmonary embolism, traction bronchiectasis consistent with late findings of COVID-19 pneumonia, and poorly circumscribed subpleural ground glass opacities. On abdominal CT, in addition to mesenteric ischemia findings, loss of wall integrity was observed in the jejunal loops due to perforation and collection areas containing air consistent with an abscess. He was treated with small bowel resection and abscess drainage. CONCLUSION: Patients with acute COVID-19 infection should be followed up for the early diagnosis of serious symptoms that may develop due to post-COVID-19 syndrome, and contrast-enhanced CT should be the imaging method of choice to detect possible mesenteric vascular thrombosis in patients with acute abdominal symptoms.

A fatal case of extensive gastrointestinal necrosis due to portal and mesenteric vein thrombosis in the post-acute phase of COVID-19.

Portal vein thrombosis (PVT) is considered a relatively rare thrombotic complication in coronavirus disease 2019 (COVID-19). Most reported cases of PVT develop within 2 weeks from COVID-19 onset. We report a fatal case of extensive gastrointestinal necrosis due to portal and mesenteric vein thrombosis approximately 6 weeks after the onset of critical COVID-19. Excessive elevation of his plasma D-dimer level had continued for weeks during the hospitalization contrary with improvement of respiratory failure. Thrombotic complication should be cautiously paid attention even in the post-acute phase of COVID-19, especially in patients with persistent elevation of plasma D-dimer level.

[Abdominal Pain Caused by Viral Infection Is Not Always Trivial]. / Bauchschmerzen bei viralem Infekt sind nicht immer trivial.

Abdominal Pain Caused by Viral Infection Is Not Always Trivial Abstract. We report on a 28-year-old previously healthy patient with initially elevated temperature and cough and developing most severe epigastric pain and peritonism in the right upper abdomen. A "bedside" sonography revealed a portal vein thrombosis, the CT additionally partial thromboses of the vena lienalis, vena mesenterica superior. During the examination, a SARS-CoV-2 infection (IgM, IgG) was confirmed. Currently (pandemic), extrapulmonary thromboembolism must also be considered. For this purpose, sonography is the appropriate "search method" - it can be used from "head to toe", immediately and at the "bedside".

Superior mesenteric vein and portal vein thrombosis in a patient with COVID-19: a rare case.

A 68-year-old man was referred to the general surgeons on account of his abdominal pain of unknown cause. He had contracted COVID-19, 9 days prior. CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein. Further investigation ruled out haematological causes, and COVID-19 was determined to be the cause. He was treated with an extended course of therapeutic dose low molecular weight heparin under the guidance of the haematology team. He was discharged once he was clinically stable and pain-free, with a plan to be followed up by both the surgeons and haematologists. This case highlights the different ways in which COVID-19 presents, and the need for clearer guidance on the treatment and prevention of thromboembolism in COVID-19.

Successful treatment of acute spleno-porto-mesenteric vein thrombosis after ChAdOx1 nCoV-19 vaccine. A case report.

Several cases of deep venous thrombosis in people who had recently received Vaxzevria (previously known as COVID-19 Vaccine AstraZeneca) have recently been reported, mainly presenting as cerebral vein/cerebral venous sinus thrombosis. This syndrome has been termed "vaccine-induced immune thrombotic thrombocytopenia (VITT)". Acute spleno-porto-mesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small-bowel gangrene and end-stage liver failure. We describe a case of concomitant thrombosis of portal, superior mesenteric and splenic veins in a young female patient with no other risk factors who received Vaxzevria (previously ChAdOx1 nCoV-19 vaccine, AstraZeneca) 17 days before. The diagnostic workup and the successful endovascular treatment and systemic anticoagulation management is reported.

Splenoportal-mesenteric axis thrombosis and splenic artery occlusion as initial presentations of COVID-19 disease.

OBJECTIVE: Although pulmonary involvement represents the primary and most characteristic presentation of Sars-Cov-2 infection, due to its innate tropism for endothelium, it is also associated with systemic pro-coagulative changes and thromboses. This paper describes a COVID-19 atypical presentation with massive thrombotic occlusion of the splenoportal-mesenteric axis and the splenic artery in the absence of clinical or radiological manifestation of pulmonary involvement. PATIENTS AND METHODS: Female patient, with no history of disease, trauma or fever in the last 30 days, was admitted to ER for persistent left subcostal pain. Laboratory exams, including inflammation, coagulation markers and Sars-CoV-2 serology, were requested. Whole-body CT with contrast media injection was performed. RESULTS: Laboratory exams showed elevated reactive C-protein, bilirubin, γ-GT and D-dimer. Whole-body CT showed: splenic artery occlusion, thrombosis of splenic, mesenteric and portal veins with portal intra-hepatic branches ectasia, juxta-hilar portal cavernomatosis of probable acute onset (absence of signs of chronic hepatopathy and of varices), a hypodense area in the spleen indicating ischemic parenchymal suffering. The patient resulted positive for Sars-CoV-2 IgG, thus in the absence of typical clinics or pulmonary parenchymal abnormality at chest CT. CONCLUSIONS: A case of acute venous thrombosis and arterial occlusion as primary manifestations of COVID-19.

Superior Mesenteric Arterial and Venous Thrombosis in COVID-19.

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.

Spontaneous portomesenteric thrombosis in a non-cirrhotic patient with SARS-CoV-2 infection.

Intra-abdominal thromboses are a poorly characterised thrombotic complication of COVID-19 and are illustrated in this case. A 42-year-old man with chronic hepatitis B (undetectable viral load, FibroScan 7.4 kPa) developed fever and cough in March 2020. 14 days later, he developed right upper quadrant pain. After being discharged with reassurance, he re-presented with worsening pain on symptom day 25. Subsequent abdominal ultrasound suggested portal vein thrombosis. CT of the abdomen confirmed portal and mid-superior mesenteric vein thromboses. Concurrent CT of the chest suggested COVID-19 infection. While reverse transcription PCR was negative, subsequent antibody serology was positive. Thrombophilia screen excluded inherited and acquired thrombophilia. Having been commenced on apixaban 5 mg two times per day, he is currently asymptomatic. This is the first case of COVID-19-related portomesenteric thrombosis described in the UK. A recent meta-analysis suggests 9.2% of COVID-19 cases develop abdominal pain. Threshold for performing abdominal imaging must be lower to avoid this reversible complication.

A Peculiar Case of Small Bowel Stricture in a Coronavirus Disease 2019 Patient with Congenital Adhesion Band and Superior Mesenteric Vein Thrombosis.

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.

A 29-Year-Old Male Construction Worker from India Who Presented with Left- Sided Abdominal Pain Due to Isolated Superior Mesenteric Vein Thrombosis Associated with SARS-CoV-2 Infection.

BACKGROUND In corona virus disease 2019 (COVID-19), which emerged in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most case presentations have been related to the respiratory tract. Several recent studies reveal that angiotensin-converting enzyme 2 (ACE2), which was found in the target cells of the virus, is highly expressed in the lungs, small bowel, and vasculature. CASE REPORT A 29-year-old male construction worker from India presented with left-sided colicky abdominal pain. He tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Isolated superior mesenteric vein thrombosis was diagnosed by CT (computed tomography) scan. He was managed by anti-coagulants and clinically improved. CONCLUSIONS This case report indicates that isolated venous thrombosis of the abdominal vessels without concurrent arterial thrombosis can be a complication of the hyper-coagulability state in COVID-19 patients. Hence, early evaluation of abdominal vessels in covid-19 patients who present with any abdominal symptoms should be considered, especially when found to have an elevated D-dimer level, as early treatment of thrombosis with low-molecular-weight heparin can have a significant impact on the therapeutic outcome.