Document Type : Case Reports

Authors

1 Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Pathology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Medical Student, Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran

5 Department of Nursing, Islamic Azad University, Tabas Branch, Tabas, Iran

6 Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran

Abstract

Novel coronavirus disease 2019 (COVID-19) as a potential health risk factor continues to spread throughout the world. Although common symptoms include headache and respiratory symptoms, some studies have suggested that COVID-19 may cause coagulation disorders and thrombolytic events, disrupt blood flow to the visceral organs, and cause some complications such as mesenteric ischemia. The authors reported four cases of acute mesenteric ischemia associated with COVID-19 confirmed in patients hospitalized in Imam Reza Hospital (a COVID-19 referral center in Mashhad University of Medical Sciences, Mashhad, Iran). The authors described the pathological findings that may be associated with this infection. The authors collected clinical data, imaging, microscopic, and operative findings of four patients with severe COVID-19 infection and evidence of intestinal necrosis. These four cases that all had severe COVID-19 pneumonia simultaneously showed intestinal necrosis during the infection process, indicating a relationship between coronavirus and mesenteric vascular events. Physicians should be aware of thrombosis symptoms in the digestive system in patients with severe COVID-19 disease.

Keywords

Main Subjects

  1. Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update [Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.
  2. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nature reviews immunology. 2020;20(6):355-62. [DOI:10.1038/s41577-020-0331-4] [PMID] [PMCID]
  3. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;506:145-8. [DOI:10.1016/j.cca.2020.03.022] [PMID] [PMCID]
  4. Fabre O, Rebet O, Carjaliu I, Radutoiu M, Gautier L, Hysi I. Severe Acute Proximal Pulmonary Embolism and COVID-19: A Word of Caution. Ann Thorac Surg. 2020;110(5):e409-e11. [DOI:10.1016/j.athoracsur.2020.04.005] [PMID] [PMCID]
  5. Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med. 2016;374(10):959-68. [DOI:10.1056/NEJMra1503884] [PMID]
  6. Zhou B, She J, Wang Y, Ma X. Venous thrombosis and arteriosclerosis obliterans of lower extremities in a very severe patient with 2019 novel coronavirus disease: a case report. J Thromb Thrombolysis. 2020;50(1):229-32. [DOI:10.1007/s11239-020-02084-w] [PMID] [PMCID]
  7. Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-4. [DOI:10.1111/jth.14830] [PMID] [PMCID]
  8. Iba T, Levy JH. Derangement of the endothelial glycocalyx in sepsis. J Thromb Haemost. 2019;17(2):283-94. [DOI:10.1111/jth.14371] [PMID]
  9. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8. [DOI:10.1016/S0140-6736(20)30937-5]
  10. Smith SA, Mutch NJ, Baskar D, Rohloff P, Docampo R, Morrissey JH. Polyphosphate modulates blood coagulation and fibrinolysis. Proc Natl Acad Sci U S A. 2006;103(4):903-8. [DOI:10.1073/pnas.0507195103] [PMID] [PMCID]
  11. Ignat M, Philouze G, Aussenac-Belle L, Faucher V, Collange O, Mutter D, et al. Small bowel ischemia and SARS-CoV-2 infection: an underdiagnosed distinct clinical entity. Surgery. 2020;168(1):14-6. [DOI:10.1016/j.surg.2020.04.035] [PMID] [PMCID]
  12. Bussani R, Schneider E, Zentilin L, Collesi C, Ali H, Braga L, et al. Persistence of viral RNA, pneumocyte syncytia and thrombosis are hallmarks of advanced COVID-19 pathology. EBioMedicine. 2020;61:103104. [DOI:10.1016/j.ebiom.2020.103104] [PMID] [PMCID]
  13. Buja LM, Wolf DA, Zhao B, Akkanti B, McDonald M, Lelenwa L, et al. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovasc Pathol. 2020;48:107233. [DOI:10.1016/j.carpath.2020.107233] [PMID] [PMCID]
  14. Emert R, Shah P, Zampella JG. COVID-19 and hypercoagulability in the outpatient setting. Thromb Res. 2020;192:122-3. [DOI:10.1016/j.thromres.2020.05.031] [PMID] [PMCID]