ACUTE MESENTERIC ISCHEMIA IN COVID-19: A DEVASTATING SEQUELAE OF A DEVASTATING DISEASE

ABSTRACT

SESSION TITLE Extraordinary Cardiovascular Reports SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/18/2022 0135 pm - 0235 pm INTRODUCTION: The COVID-19 pandemic has reshaped modern history with an estimated death count over 6 million globally. Symptoms are primarily respiratory;however, COVID also confers an increased risk for hypercoagulability with the common presentations of venous and small vessel arterial thrombi (1). Acute mesenteric ischemia (AMI) is rare. We present a case of severe AMI with arterial and venous thrombi related to COVID. CASE PRESENTATION A 50-year-old non-COVID-vaccinated male with a history of alcohol abuse presented with 1 day of emesis and abdominal pain and was found to be COVID-19 positive without respiratory symptoms. Computed tomography angiogram of the chest, abdomen and pelvis revealed normal lungs, extensive non-calcified thrombi in the abdominal aorta extending into the celiac artery causing severe stenosis, complete occlusion of the superior mesenteric, right portal, and splenic veins, partial occlusion of the extrahepatic portal vein, left lower pulmonary embolism, small bowel perfusion injury, and splenic and right hepatic lobe infarcts. He denied a personal or family history of hypercoagulability. The patient was placed on a heparin drip and underwent placement of a transjugular intrahepatic portosystemic shunt and an infusion catheter for administration of tissue plasminogen activator into the portal vein. He ultimately required a thrombectomy. Later imaging showed patency of previously occluded vessels and resolution of arterial thrombus. Over the course of his hospitalization, his respiratory status did decompensate, and he required 13 days of mechanical ventilation, after which he was extubated, transitioned to warfarin, and discharged. DISCUSSION: AMI in COVID has been identified as a rare but serious complication with a reported incidence of 3-4%, with a reported mortality of up to 47% in all-cause-related AMI(2,3). COVID causes a prothrombotic state due to its affinity to angiotensin-converting enzyme-2(ACE2) receptors on enterocytes and endothelium, allowing it to infect the cells and causing direct damage to bowel tissue and vessels. The binding of ACE2 also increases IL-6, inducing cytokine storm and hypercoagulability (1). While there are no clear guidelines, treatment mainly involves revascularization and removal of necrotic bowel. Anticoagulation generally has favorable results within 48 hours and invasive intervention is not required (1,4). Thus, early recognition of AMI as a potential complication of COVID is essential for early treatment and reduction of the staggering morbidity and mortality. CONCLUSIONS: While the incidence of AMI in COVID is low, it can have severe effects on patients and requires early recognition and treatment. Further studies are needed to develop awareness of the disease, therefore improving surveillance and standard of care to minimize the chances of these poor outcomes. Reference #1 Patel, Suyog et al. "Bowel ischemia in COVID-19 A systematic review.” International journal of clinical practice vol. 75,12 (2021) e14930. doi10.1111/ijcp.14930 Reference #2 Kaafarani, Haytham M A et al. "Gastrointestinal Complications in Critically Ill Patients With COVID-19.” Annals of surgery vol. 272,2 (2020) e61-e62. doi10.1097/SLA.0000000000004004 Reference #3 Cudnik, Michael T et al. "The diagnosis of acute mesenteric ischemia A systematic review and meta-analysis.” Academic emergency medicine official journal of the Society for Academic Emergency Medicine vol. 20,11 (2013) 1087-100. doi10.1111/acem.12254 Chen, Can et al. "Acute Mesenteric Ischemia in Patients with COVID-19 Review of the literature.” Journal of the National Medical Association vol. 114,1 (2022) 47-55. doi10.1016/j.jnma.2021.12.003 DISCLOSURES No relevant relationships by Mohamed Abdelhabib No relevant relationships by Naomi Habib No relevant relationships by Daniel Rabulinski No relevant relationships by Suresh Uppalapu