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Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report.
Dinoto, E; Ferlito, F; La Marca, M A; Mirabella, D; Bajardi, G; Pecoraro, F.
  • Dinoto E; Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy. Electronic address: ettoredinoto@gmail.com.
  • Ferlito F; Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
  • La Marca MA; Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
  • Mirabella D; Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
  • Bajardi G; Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences - University of Palermo, Italy.
  • Pecoraro F; Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences - University of Palermo, Italy.
Int J Surg Case Rep ; 84: 106105, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1265733
ABSTRACT

INTRODUCTION:

COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). PRESENTATION OF CASE An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombectomy and stenting with a good result.

DISCUSSION:

Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure - gastrointestinal decompression, fluid resuscitation, hemodynamic support. Endovascular management of AMI is preferred over the standard surgical approach due to a reduced mortality and morbidity rates. Imaging findings of intestinal necrosis, however, represent an indication for AMI surgical treatment with explorative laparotomy. Different endovascular solutions have been employed to address AMI including mechanical thrombectomy, local thrombolysis, and PTA-stenting.

CONCLUSION:

COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. If a first embolic event occurs, an aggressive anticoagulation treatment could be inefficient to reduce the risk of subsequent embolization events. The limited life expectancy of such revascularization procedures should orientate towards less invasive treatments.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Int J Surg Case Rep Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Int J Surg Case Rep Year: 2021 Document Type: Article