Does COVID-19 provoke aggressive form of acute mesenteric thrombosis? A comparative study

ABSTRACT

Background Coronavirus disease 2019 (COVID-19) elicits thrombotic events, among which acute mesenteric thrombosis (AMT) might be very serious. Patients and methods Eligible patients with AMT who presented to Sohag University Hospital (January 2020-August 2021) were retrospectively studied. Patients were classified into group A (without) versus group B (with) COVID-19. Group B was subdivided into B-1 with mild symptoms and B-2 with peritonitis, all received treatment according to ;damage-control' protocol. Results Fifteen patients were eligible (nine males and six females) with median age of 66 (range 38-81) years. Group B patients (10) were admitted during the last 35% of the study period (7 months) and exhibited delayed presentation compared with group A (five patients), P value less than 0.05. In group A, three patients with arterial thrombosis underwent laparotomy during which ischemic bowel segments were resected. Two patients had venous thrombosis and recovered under therapeutic anticoagulation. All group B patients suffered from mixed pattern of AMT (arterial and venous). Group B-1 (five patients) received initially anticoagulation, which was successful in two. Peritonitis developed in three, who required either repair of small-bowel perforations or resection of gangrenous segments. All five patients in group B-2 underwent upfront laparotomy due to peritonitis, gangrenous small bowel and colon of variable lengths were found and resected. The overall mortality rate was 33.3% (five patients died). However, death rate was significantly higher in group B (40%) compared with group A (20%), P value less than 0.05. Conclusions COVID-19 triggers aggressive variety of AMT with worse clinical outcome.