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Case Reports
. 2024 Jun 11;16(6):e62136.
doi: 10.7759/cureus.62136. eCollection 2024 Jun.

Superior Mesenteric Artery Thrombosis in COVID-19-Positive Patients: A Rare Coincidence

Rushabh Parekh  1 , Virendra Athavale  1 , Saili Kelshikar  1
Affiliations
Case Reports

Superior Mesenteric Artery Thrombosis in COVID-19-Positive Patients: A Rare Coincidence

Rushabh Parekh et al. Cureus. .

Abstract

Since the start of the SARS-CoV-2 pandemic, which is otherwise known as the worldwide coronavirus disease, 2019, has had a well-established pro-thrombotic character. Patients often first exhibit respiratory symptoms, and those whose severity increases eventually develop acute hypoxic respiratory failure. The systemic hypercoagulable condition and arterial/venous thrombosis related to COVID-19 have a poor prognosis. Even though superior mesenteric artery (SMA) thrombosis and acute mesenteric ischemia (AMI) are uncommon, they frequently coexist with fatal gastrointestinal (GI) pathologies that necessitate prompt diagnosis and treatment by the doctor. This calls for more research into the effects of anticoagulation therapy in COVID-19-positive patients. The main treatment aims for this condition are early detection, surgical or intravascular re-establishment of blood supply to the ischemic bowel, and surgical resection. The study aimed to see the outcome after surgical intervention in patients with SMA thrombosis post-COVID-19 infection. This study was from March 2021 to January 2022, with a sample size of 5 patients with SMA thrombosis, which was confirmed on contrast-enhanced computed tomography (CECT) abdomen and pelvis with angiography. The patients underwent exploratory laparotomy. Bowel resection and anastomosis were performed in three individuals; bowel resection and stoma placement were performed in two patients. Doctors have significant clinical challenges as a result of the thromboembolic manifestations of the unexpected and deadly nature of the virus, such as AMI. The high morbidity and mortality associated with AMI calls for further study on prophylactic anticoagulation therapy in COVID-19-positive individuals.

Keywords: acute abdomen in covid-19; bowel ischemia; covid-19; superior mesenteric artery thrombosis; surgical emergencies.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. (A and B) CECT of the abdomen and pelvis with angiography of the patient (arrows showing SMA thrombosis and air-fluid levels).
CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 2
Figure 2. CECT of the abdomen and pelvis with angiography of the patient: (A) sagittal section and (B) coronal section.
Arrows are showing SMA thrombosis with dilated jejunal and proximal ileal loops. CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 3
Figure 3. Resected specimen of the gangrenous bowel.
Figure 4
Figure 4. (A and B) CECT of the abdomen and pelvis with angiography of the patient (arrows showing a partial filling defect in the SMA along its posterior and left lateral wall).
CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 5
Figure 5. CECT of the abdomen and pelvis with angiography of the patient (arrows mild hypo-enhancement of the walls with a mildly dilated caliber of ileal loops and pneumatosis).
CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 6
Figure 6. Intra-op photo of the gangrenous bowel.
Figure 7
Figure 7. (A and B) CECT of the abdomen and pelvis with angiography of the patient (arrows showing the SMA thrombosis and thrombosed portal confluence).
CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 8
Figure 8. CECT of the abdomen and pelvis with angiography of the patient, with arrows showing (A) hepatic infarcts, (B) renal infarcts, and (C) shrunken spleen with splenic infarct.
CECT, contrast-enhanced computed tomography
Figure 9
Figure 9. (A and B) CECT of the abdomen and pelvis with angiography of the patient (arrows showing the SMA thrombosis).
CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 10
Figure 10. CECT of the abdomen and pelvis with angiography of the patient: (A) sagittal section and (B) coronal section (arrows showing the SMA thrombosis)
CECT, contrast-enhanced computed tomography; SMA, superior mesenteric artery
Figure 11
Figure 11. CECT of the abdomen and pelvis of the patient.
CECT, contrast-enhanced computed tomography
Figure 12
Figure 12. Intra-op photo of the gangrenous small bowel.
See this image and copyright information in PMC

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