Superior Mesenteric Arterial and Venous Thrombosis in COVID-19

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Gastroenterology

Background:

• Coronavirus disease 2019 (COVID-19) often presents with respiratory symptoms, but atypical presentations, including vascular complications, are increasingly recognized.
• Mesenteric ischemia, a critical condition affecting blood supply to the intestines, can be a rare manifestation of COVID-19.
• While isolated mesenteric arterial occlusion has been documented, combined arterial and venous thrombosis is exceptionally uncommon.

Observation:

• A 45-year-old male healthcare worker presented with severe abdominal pain.
• Imaging revealed acute mesenteric ischemia due to simultaneous occlusion of the superior mesenteric artery and vein.
• Chest imaging suggested COVID-19 infection, later confirmed by RT-PCR.

Findings:

• This case represents one of the few documented instances of combined superior mesenteric artery and vein thrombosis associated with COVID-19.
• The patient's presentation underscores the diverse and severe gastrointestinal complications that can arise from SARS-CoV-2 infection.
• The rapid progression of mesenteric ischemia necessitates prompt diagnosis and management.

Implications:

• Emergency physicians should consider mesenteric ischemia in the differential diagnosis for patients presenting with unexplained abdominal pain during the COVID-19 pandemic.
• Integrating high-resolution chest CT scans with abdominal imaging may aid in the early identification of concurrent COVID-19 in acute abdomen cases.
• This case emphasizes the need for heightened awareness of thrombotic events as a potential complication of COVID-19, extending beyond pulmonary manifestations.