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1.
J Infect Chemother ; 28(1): 108-111, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1474738

ABSTRACT

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.


Subject(s)
COVID-19 , Thrombosis , Humans , Mesenteric Veins , Necrosis , Portal Vein/diagnostic imaging , SARS-CoV-2
2.
Pan Afr Med J ; 39: 273, 2021.
Article in French | MEDLINE | ID: covidwho-1472500

ABSTRACT

Acute mesenteric ischemia (AMI) is due to a sudden decrease or interruption of mesenteric blood flow resulting in inadequate blood supply to the gastrointestinal tract. This causes ischemic and inflammatory lesions often progressing to necrosis in the absence of appropriate treatment. Vascular insufficiency may arise as a result of embolism or arterial thrombosis or venous thrombosis. We here report a rare case of mesenteric venous ischemia caused by coronavirus disease 2019 (COVID-19) in a 33-year-old man in whom diagnosis was based on ultrasound and, in particular, on computed tomography (CT).


Subject(s)
COVID-19/complications , Intestines/blood supply , Mesenteric Ischemia/etiology , Tomography, X-Ray Computed/methods , Venous Thrombosis/complications , Abdominal Pain/etiology , Adult , COVID-19/diagnosis , Humans , Male , Mesenteric Ischemia/diagnostic imaging , Mesentery/blood supply , Portal Vein/diagnostic imaging , SARS-CoV-2 , Venous Thrombosis/diagnosis
4.
BMJ Case Rep ; 14(8)2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1356920

ABSTRACT

A COVID-19 infection predisposes the infected person to thrombotic events. Myocardial infarction, acute limb ischaemia, mesenteric artery thrombosis and pulmonary embolism are all well-documented complications of this infection. Here we describe a pregnant patient who presented with obstructed labour with asymptomatic COVID-19 infection and developed ascites during the postoperative period. Further work-up of the patient revealed portal hypertension due to portal vein thrombosis (PVT). As the patient was healthy before this index pregnancy, a causative link between COVID-19 and PVT cannot be ruled out. Her COVID-19 infection progressed to a moderate disease. She was managed with steroids and appropriate antibiotics for secondary bacterial peritonitis. She was finally discharged after 2.5 months of multidisciplinary treatment. This is a case of a survivor of complications due to pregnancy, COVID-19 and extrahepatic portal vein obstruction.


Subject(s)
COVID-19 , Thrombosis , Female , Humans , Portal Vein/diagnostic imaging , Pregnancy , SARS-CoV-2 , Survivors
5.
Acta Gastroenterol Belg ; 84(2): 269-270, 2021.
Article in English | MEDLINE | ID: covidwho-1332571
6.
Praxis (Bern 1994) ; 110(8): 449-451, 2021 Jun.
Article in German | MEDLINE | ID: covidwho-1281672

ABSTRACT

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".


Subject(s)
COVID-19 , Abdominal Pain/etiology , Adult , Humans , Mesenteric Veins , Portal Vein , SARS-CoV-2
7.
BMJ Case Rep ; 14(6)2021 Jun 22.
Article in English | MEDLINE | ID: covidwho-1280408

ABSTRACT

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.


Subject(s)
COVID-19 , Thrombosis , Aged , Humans , Male , Mesenteric Veins/diagnostic imaging , Portal Vein/diagnostic imaging , SARS-CoV-2
9.
Cir Cir ; 89(3): 399-402, 2021.
Article in English | MEDLINE | ID: covidwho-1244411

ABSTRACT

La infección por el virus SARS-CoV-2 provoca, además de cuadros respiratorios graves, episodios trombóticos en múltiples localizaciones debido a una mala regulación de la respuesta inmune. Presentamos el caso de un paciente con colecistitis incipiente que desarrolló trombosis portal aguda sin ningún otro antecedente salvo haber pasado de forma asintomática una infección por COVID-19. Dado que esta complicación es extremadamente infrecuente en pacientes sin factores predisponentes ni infecciones graves, consideramos que la infección por COVID-19 pudo ser un factor desencadenante de la trombosis portal y debemos de tenerlo en cuenta de cara al manejo y tratamiento de futuros casos similares.Severe acute respiratory syndrome coronavirus 2019 infection causes, in addition to severe respiratory symptoms, thrombotic episodes in multiple locations due to dysregulation of the immune response. We present the case of a patient with incipient cholecystitis who developed acute portal thrombosis with no other antecedents except having passed an asymptomatic coronavirus disease 2019 (COVID-19) infection. Since this complication is extremely rare in patients without predisposing factors or serious infections, we consider that COVID-19 infection could be a triggering factor for portal thrombosis and we must take it into account in the management and treatment of future similar cases.


Subject(s)
COVID-19/complications , Cholecystitis/complications , Portal Vein , Thrombosis/etiology , Acute Disease , Asymptomatic Infections , COVID-19/immunology , Cholecystitis/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Portal Vein/diagnostic imaging , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed
14.
BMJ Case Rep ; 13(12)2020 Dec 28.
Article in English | MEDLINE | ID: covidwho-1020894

ABSTRACT

We present a previously healthy man in his 30s who presented with typical viral prodrome symptoms and worsening abdominal pain. He was found to have portal vein thrombosis, with extensive hypercoagulability workup performed. It was determined that the aetiology of thrombus was secondary to acute cytomegalovirus infection. The patient was started on anticoagulation therapy, with later clot resolution demonstrated on abdominal Doppler ultrasound and abdominal CT scan. Given the atypical presentation of this common virus, we performed a literature review of cytomegalovirus-associated portal vein thrombosis in healthy individuals; we found that most patients present with non-specific symptoms of fever and abdominal pain in the setting of a viral prodrome. This case and literature review suggest physicians must consider cytomegalovirus-associated portal vein thrombosis as a potential diagnosis when patients present with abdominal pain and viral symptoms. The literature highlights the need for a consensus on anticoagulation and antiviral therapy.


Subject(s)
Cytomegalovirus Infections/complications , Portal Vein , Venous Thrombosis/virology , Abdominal Pain/etiology , Adult , Anticoagulants/therapeutic use , Blood Coagulation Disorders/drug therapy , Blood Coagulation Disorders/virology , Computed Tomography Angiography , Cytomegalovirus Infections/immunology , Humans , Immunocompetence , Male , Portal Vein/diagnostic imaging , Ultrasonography, Doppler , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy
15.
BMJ Case Rep ; 13(12)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-999235

ABSTRACT

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.


Subject(s)
COVID-19 , Hepatitis B, Chronic/complications , Mesenteric Ischemia , Mesenteric Veins/diagnostic imaging , Portal Vein/diagnostic imaging , Pyrazoles/administration & dosage , Pyridones/administration & dosage , SARS-CoV-2/isolation & purification , Abdominal Pain/diagnosis , Adult , COVID-19/blood , COVID-19/complications , COVID-19/therapy , COVID-19 Serological Testing/methods , Diagnosis, Differential , Factor Xa Inhibitors/administration & dosage , Humans , Male , Mesenteric Ischemia/etiology , Mesenteric Ischemia/physiopathology , Mesenteric Ischemia/therapy , Portography/methods , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography/methods
16.
BMC Gastroenterol ; 20(1): 386, 2020 Nov 19.
Article in English | MEDLINE | ID: covidwho-934253

ABSTRACT

BACKGROUND: COVID-19 pneumonia exhibits several extra-pulmonary complications. CASE PRESENTATION: A 23-year old, asthmatic male with coronavirus pneumonia developed with generalized, acute abdominal pain. Further evaluations revealed a mild ascites and portal vein thrombosis although the patient received proper anticoagulation therapy. Routine lab data regarding the secondary causes of portal vein thrombosis were normal. CONCLUSION: We speculated that the underlying cause of portal vein thrombosis in our case was coronaviruses. Therefore, clinicians should always consider thrombosis and other hypercoagulable diseases in patients with COVID-19.


Subject(s)
COVID-19/diagnosis , Portal Vein , Venous Thrombosis/virology , Acute Disease , COVID-19/complications , COVID-19 Testing , Humans , Male , Venous Thrombosis/diagnosis , Young Adult
20.
Liver Int ; 40(9): 2110-2116, 2020 09.
Article in English | MEDLINE | ID: covidwho-639586

ABSTRACT

SARS2-CoV-2 breakout in Italy caused a huge number of severely ill patients with a serious increase in mortality. Although lungs seem to be the main target of the infection, very few information are available about liver involvement, possibly evocating a systemic disease. Post-mortem wedge liver biopsies from 48 patients died from severe pulmonary COVID-19 disease with respiratory failure were collected from two main hospitals in northern Italy. No patient had clinical symptoms of liver disease or signs of liver failure before and during hospitalization; for each of them liver function tests were available. All liver samples showed minimal inflammation features. Histological pictures compatible with vascular alterations were observed, characterized by increase in number of portal vein branches associated with lumen massive dilatation, partial or complete luminal thrombosis of portal and sinusoidal vessels, fibrosis of portal tract, focally markedly enlarged and fibrotic. SARS-CoV-2 was found in 15 of 22 samples tested by in situ hybridization method. Our preliminary results confirm the clinical impression that liver failure is not a main concern and this organ is not the target of significant inflammatory damage. Histopathological findings are highly suggestive for marked derangement of intrahepatic blood vessel network secondary to systemic changes induced by virus that could target not only lung parenchyma but also cardiovascular system, coagulation cascade and endothelial layer of blood vessels. It still remains unclear if the mentioned changes are directly related to virus infection or if SARS-CoV-2 triggers a series of reactions leading to striking vascular alterations.


Subject(s)
Coronavirus Infections/pathology , Liver/pathology , Pneumonia, Viral/pathology , Portal Vein/pathology , Respiratory Insufficiency/pathology , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Female , Humans , Liver/blood supply , Liver/enzymology , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Respiratory Insufficiency/virology , SARS-CoV-2
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