Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report
Open accessAbstract
INTRODUCTION: COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). PRESENTATION OF CASE: An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombectomy and stenting with a good result. DISCUSSION: Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure - gastrointestinal decompression, fluid resuscitation, hemodynamic support. Endovascular management of AMI is preferred over the standard surgical approach due to a reduced mortality and morbidity rates. Imaging findings of intestinal necrosis, however, represent an indication for AMI surgical treatment with explorative laparotomy. Different endovascular solutions have been employed to address AMI including mechanical thrombectomy, local thrombolysis, and PTA-stenting. CONCLUSION: COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. If a first embolic event occurs, an aggressive anticoagulation treatment could be inefficient to reduce the risk of subsequent embolization events. The limited life expectancy of such revascularization procedures should orientate towards less invasive treatments.
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30 case reports or case series presented 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings.
“We also identified 30 case reports or case series [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51] presenting 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings.”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [28]
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- Authors
- Dinoto, E., Ferlito, F., La Marca, M. A., Mirabella, D., Bajardi, G., & Pecoraro, F.
- Affiliations
- Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT)
- Corresponding author
- Dinoto, E.
- Venue
- International Journal of Surgery Case Reports
- Published
- 2021-07
- Volume
- 84
- Pages
- 106105
- ISSN
- 2210-2612 (ISSN-L)
- PMC
- PMC8188776
- OpenAlex
- W3169348695
- Cited by
- 16
- References
- 17
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 7
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Surgery Case Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS UniPA (University of Palermo) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Ophthalmology › Retinal and Optic Conditions
- Keywords
- COVID-19 pandemic, acute mesenteric ischemia, acute limb ischemia, superior mesenteric artery occlusion, endovascular treatment, mechanical thrombectomy, stenting, intestinal necrosis, coagulopathy, anticoagulation, elderly patients, diabetes mellitus
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