Approach To Superior Mesenteric Artery Thrombus By Interventional Radiology- A Rare Presentation of COVID-19: A Case Report

Abstract

The COVID-19 disease caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Though this disease primarily presents as a lower respiratory tract infection, multiple digestive manifestations have been reported which are often overlooked. The present case report describes the unusual progression of COVID-19 disease from pneumonia to a procoagulant state leading to superior mesenteric artery thrombosis and subsequent gut ischemia. A thrombus in the superior mesenteric artery (SMA) is a critical condition that requires immediate diagnosis and treatment. We present a COVID 19 Positive case with a thrombus in SMA that was successfully treated by interventional radiology. A 36-year-old male with a history of respiratory symptoms admitted to our hospital. On day 2, he developed abdominal pain, Physical examination of his abdomen revealed tenderness over the upper abdomen without any signs of peritonitis, so ultrasound of abdomen done which showed fatty liver and mildly distended gall bladder, therefore, a proton pump inhibitor was administered and fasting treatment was resumed. On day 3, he presented with recurrent severe upper abdominal pain. Contrast-enhanced computed tomography (CT) was performed, revealing a suspected thrombus in the main trunk of SMA, low molecular weight heparin was subcutaneously administered. On day 4, abdominal angiography was performed, revealing an occluded thrombus in the proximal SMA with developed circulation in peripheral intestinal arteries. Subsequently, the thrombus was successfully resolved by, thrombolysis and thrombus aspiration through interventional radiology (IVR).On day 5, Check DSA abdominal aorta angiography was then performed, it revealed complete recanalization of superior mesenteric artery and its branches with almost complete resolution of thrombosis. The overall clinical course was uneventful, and oral feeding along with oral administration of aspirin and warfarin was initiated on day 8. Coagulopathy in COVID-19 is due to an imbalance in the coagulation homeostasis with increase in thrombocytes in contrast to thrombocytopenia documented in cases of dissemination intravascular coagulation and sepsis. Early recognition of abdominal symptoms, diagnosis of pathology and timely intervention radiological or surgical may definitely improve outcome.

Keywords: COVID-19, SARS-CoV-2,Acute Mesenteric Ischemia; Superior Mesenteric Artery Thrombosis; Occlusion; Thrombus; Interventional radiology.