Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection

Cheung, Szeya; Quiwa, Joseph C.; Pillai, Ajish; Onwu, Chuks; Tharayil, Zubin J.; Gupta, Ravi

Patient: Male, 55-year-old Final Diagnosis: Acute intestinal infarction • COVID provoked thromboembolism • superior mesenteric artery thrombosis Symptoms: Abdominal pain • diarrhea • nausea Medication:— Clinical Procedure: Exploratory laparotomy • primary anastomosis • small bowel resection • thromboembolectomy Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Surgery OBJECTIVE: Unusual clinical course 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 SARSCoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.