Acute superior mesenteric artery thrombosis seven days after discharge for novel coronavirus pneumonia (NCP)

Bannazadeh, Mohsen; Tassiopoulos, Apostolos; Koullias, George

Since the emergence of novel coronavirus pneumonia (NCP), a number of reports have pointed out an increased coagulation activity in these patients mostly during acute phase of the disease. We are reporting a case of acute superior mesenteric thrombosis in a 55-year-old male with NCP one week after hospital discharge. He returned to the emergency department 7 days later with severe acute abdominal pain and found to have superior mesenteric artery thrombosis. He subsequently underwent emergent exploratory laparotomy, SMA thrombectomy and bowel resection. Acute arterial thrombosis may occur in post hospitalization period in patients with NPC. Since the emergence of novel coronavirus pneumonia (NCP) in December 2019, a number of reports have suggested that a large percentage of patients with novel coronavirus (COVID-19) infection , particularly those that become critically ill, develop a pro-thrombotic state which places them at a significantly increased risk of thrombosis especially during the acute phase that often requires intensive care unit stay with severe acute respiratory distress syndrome (ARDS). 1, 2, 3 Interestingly, a wide range of increase in D-dimer levels has also been documented in hospitalized COVID-19 patients and there are early reports linking higher D-dimer levels to worse outcomes.(4) Based on these reports, most centers employ thrombosis-prevention strategies ranging from prophylactic regimens to full anticoagulation during NCP hospitalization with improved outcomes.(5) The optimal potency and duration of anti-thrombotic management is not clear. In addition, there is little evidence on when the increased coagulation activity returns to normal levels after onset of symptoms. We report a case of acute mesenteric ischemia due to superior mesenteric artery thrombosis in a 55-year-old male patient with NCP one week after hospital discharge. The patient consent to publish the case report was obtained according to our institutional guidelines.