Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection.
Identifieur interne : 001045 ( Main/Corpus ); précédent : 001044; suivant : 001046Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection.
Auteurs : Szeya Cheung ; Joseph C. Quiwa ; Ajish Pillai ; Chuks Onwu ; Zubin J. Tharayil ; Ravi GuptaSource :
- The American journal of case reports [ 1941-5923 ] ; 2020.
English descriptors
- KwdEn :
- Abdominal Pain (etiology), Betacoronavirus (MeSH), COVID-19 (MeSH), Coronavirus Infections (complications), Diarrhea (etiology), Embolectomy (MeSH), Humans (MeSH), Infarction (diagnosis), Infarction (surgery), Infarction (virology), Intestines (blood supply), Intestines (diagnostic imaging), Intestines (surgery), Ischemia (diagnostic imaging), Ischemia (surgery), Ischemia (virology), Male (MeSH), Mesenteric Artery, Superior (diagnostic imaging), Mesenteric Artery, Superior (surgery), Mesenteric Vascular Occlusion (diagnostic imaging), Mesenteric Vascular Occlusion (surgery), Mesenteric Vascular Occlusion (virology), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (complications), SARS-CoV-2 (MeSH), Thrombectomy (MeSH), Thrombosis (diagnostic imaging), Thrombosis (surgery), Thrombosis (virology), Tomography, X-Ray Computed (MeSH).
- MESH :
- blood supply : Intestines.
- complications : Coronavirus Infections, Pneumonia, Viral.
- diagnosis : Infarction.
- diagnostic imaging : Intestines, Ischemia, Mesenteric Artery, Superior, Mesenteric Vascular Occlusion, Thrombosis.
- etiology : Abdominal Pain, Diarrhea.
- surgery : Infarction, Intestines, Ischemia, Mesenteric Artery, Superior, Mesenteric Vascular Occlusion, Thrombosis.
- virology : Infarction, Ischemia, Mesenteric Vascular Occlusion, Thrombosis.
- Betacoronavirus, COVID-19, Embolectomy, Humans, Male, Middle Aged, Pandemics, SARS-CoV-2, Thrombectomy, Tomography, X-Ray Computed.
Abstract
BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.
DOI: 10.12659/AJCR.925753
PubMed: 32724028
PubMed Central: PMC7417027
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Quiwa</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pillai, Ajish" sort="Pillai, Ajish" uniqKey="Pillai A" first="Ajish" last="Pillai">Ajish Pillai</name><affiliation><nlm:affiliation>Department of Internal Medicine, Division of Gastroenterology, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Onwu, Chuks" sort="Onwu, Chuks" uniqKey="Onwu C" first="Chuks" last="Onwu">Chuks Onwu</name><affiliation><nlm:affiliation>Department of General Surgery, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Tharayil, Zubin J" sort="Tharayil, Zubin J" uniqKey="Tharayil Z" first="Zubin J" last="Tharayil">Zubin J. Tharayil</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gupta, Ravi" sort="Gupta, Ravi" uniqKey="Gupta R" first="Ravi" last="Gupta">Ravi Gupta</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32724028</idno><idno type="pmid">32724028</idno><idno type="doi">10.12659/AJCR.925753</idno><idno type="pmc">PMC7417027</idno><idno type="wicri:Area/Main/Corpus">001045</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001045</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection.</title><author><name sortKey="Cheung, Szeya" sort="Cheung, Szeya" uniqKey="Cheung S" first="Szeya" last="Cheung">Szeya Cheung</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Quiwa, Joseph C" sort="Quiwa, Joseph C" uniqKey="Quiwa J" first="Joseph C" last="Quiwa">Joseph C. Quiwa</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pillai, Ajish" sort="Pillai, Ajish" uniqKey="Pillai A" first="Ajish" last="Pillai">Ajish Pillai</name><affiliation><nlm:affiliation>Department of Internal Medicine, Division of Gastroenterology, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Onwu, Chuks" sort="Onwu, Chuks" uniqKey="Onwu C" first="Chuks" last="Onwu">Chuks Onwu</name><affiliation><nlm:affiliation>Department of General Surgery, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Tharayil, Zubin J" sort="Tharayil, Zubin J" uniqKey="Tharayil Z" first="Zubin J" last="Tharayil">Zubin J. Tharayil</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gupta, Ravi" sort="Gupta, Ravi" uniqKey="Gupta R" first="Ravi" last="Gupta">Ravi Gupta</name><affiliation><nlm:affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">The American journal of case reports</title><idno type="eISSN">1941-5923</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Abdominal Pain (etiology)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Diarrhea (etiology)</term><term>Embolectomy (MeSH)</term><term>Humans (MeSH)</term><term>Infarction (diagnosis)</term><term>Infarction (surgery)</term><term>Infarction (virology)</term><term>Intestines (blood supply)</term><term>Intestines (diagnostic imaging)</term><term>Intestines (surgery)</term><term>Ischemia (diagnostic imaging)</term><term>Ischemia (surgery)</term><term>Ischemia (virology)</term><term>Male (MeSH)</term><term>Mesenteric Artery, Superior (diagnostic imaging)</term><term>Mesenteric Artery, Superior (surgery)</term><term>Mesenteric Vascular Occlusion (diagnostic imaging)</term><term>Mesenteric Vascular Occlusion (surgery)</term><term>Mesenteric Vascular Occlusion (virology)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>SARS-CoV-2 (MeSH)</term><term>Thrombectomy (MeSH)</term><term>Thrombosis (diagnostic imaging)</term><term>Thrombosis (surgery)</term><term>Thrombosis (virology)</term><term>Tomography, X-Ray Computed (MeSH)</term></keywords><keywords scheme="MESH" qualifier="blood supply" xml:lang="en"><term>Intestines</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Infarction</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Intestines</term><term>Ischemia</term><term>Mesenteric Artery, Superior</term><term>Mesenteric Vascular Occlusion</term><term>Thrombosis</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Abdominal Pain</term><term>Diarrhea</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Infarction</term><term>Intestines</term><term>Ischemia</term><term>Mesenteric Artery, Superior</term><term>Mesenteric Vascular Occlusion</term><term>Thrombosis</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Infarction</term><term>Ischemia</term><term>Mesenteric Vascular Occlusion</term><term>Thrombosis</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term><term>COVID-19</term><term>Embolectomy</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>SARS-CoV-2</term><term>Thrombectomy</term><term>Tomography, X-Ray Computed</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32724028</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>01</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>18</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1941-5923</ISSN><JournalIssue CitedMedium="Internet"><Volume>21</Volume><PubDate><Year>2020</Year><Month>Jul</Month><Day>29</Day></PubDate></JournalIssue><Title>The American journal of case reports</Title><ISOAbbreviation>Am J Case Rep</ISOAbbreviation></Journal><ArticleTitle>Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection.</ArticleTitle><Pagination><MedlinePgn>e925753</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.12659/AJCR.925753</ELocationID><Abstract><AbstractText>BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cheung</LastName><ForeName>Szeya</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Quiwa</LastName><ForeName>Joseph C</ForeName><Initials>JC</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pillai</LastName><ForeName>Ajish</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Division of Gastroenterology, Long Island Community Hospital, Patchogue, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Onwu</LastName><ForeName>Chuks</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of General Surgery, Long Island Community Hospital, Patchogue, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tharayil</LastName><ForeName>Zubin J</ForeName><Initials>ZJ</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gupta</LastName><ForeName>Ravi</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>07</Month><Day>29</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Case Rep</MedlineTA><NlmUniqueID>101489566</NlmUniqueID><ISSNLinking>1941-5923</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D015746" MajorTopicYN="N">Abdominal Pain</DescriptorName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003967" MajorTopicYN="N">Diarrhea</DescriptorName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017128" MajorTopicYN="N">Embolectomy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007238" MajorTopicYN="N">Infarction</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007422" MajorTopicYN="N">Intestines</DescriptorName><QualifierName UI="Q000098" MajorTopicYN="Y">blood supply</QualifierName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007511" MajorTopicYN="N">Ischemia</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName><QualifierName UI="Q000821" MajorTopicYN="Y">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017538" MajorTopicYN="N">Mesenteric Artery, Superior</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008641" MajorTopicYN="N">Mesenteric Vascular Occlusion</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName><QualifierName UI="Q000821" MajorTopicYN="Y">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017131" MajorTopicYN="N">Thrombectomy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013927" MajorTopicYN="N">Thrombosis</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName><QualifierName UI="Q000821" MajorTopicYN="Y">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014057" 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