article = {SCR-2021-1-114}
title = {Acute Ischaemic Enterocolitis Due to a Thrombotic Event in a COVID-19 Patient}
journal = {Surgical Case Reports}
year = {2021}
issn = {2613-5965}
doi = {http://dx.doi.org/10.31487/j.SCR.2021.01.14}
url = {https://www.sciencerepository.org/acute-ischaemic-enterocolitis-due-to-a-thrombotic-event-in-a_SCR-2021-1-114 
author = {Montse Adell  Trapé,Anna Curell  Garcia,Xavier Guri  Azogue,Adriana Carolina  Zucchiatti Llanos,Francesc Xavier  Nuvials Casals,Elizabeth  Pando,}
keywords = { COVID-19, thrombotic event, ischaemic enterocolitis, urgent exploratory laparotomy}
abstract ={We describe the case of a COVID-19 patient who developed an intestinal ischaemia with thrombotic origin,
confirmed by anatomo-pathological examination. A middle-aged woman affected with COVID-19 was
evaluated in March 2020. Reverse transcriptase-polymerase chain reaction (RT-PCR) to detect SARS-CoV2 was performed. On the 16th day of being hospitalized, she presented with hemodynamic and respiratory
impairment. The physical examination revealed abdominal distension. An urgent abdominal CT scan
reported signs of pneumatosis in the distal ileum and ascending colon suggestive of ischaemia (Figure 1D),
with mural irregularity predominantly in the ileum. An urgent exploratory laparotomy was performed.
Ischaemia of the right colon, as well as patched ischaemia of the distal and middle ileum, was found (Figures
2A & 2B). A right hemicolectomy and resection of the distal-middle ileum with a terminal ileostomy were
performed. Pathological examination reported: severe ischaemic colitis, with areas of mucosal necrosis and
the presence of abundant small-calibre thrombi in the submucosa and medium-caliber vessels of the
mesocolon. Re-examination of the CT scan revealed findings consistent with right lower lobe segmental
pulmonary embolism, as well as inferior vena cava filling defects consistent with thrombi. COVID-19 is
associated with a large and misleading field of complications, including coagulopathy. The combination of
viral injury, cytokine release, and damage-associated molecular patterns induce localized microvascular
inflammation, which triggers endothelial activation, leading to vasodilation and prothrombotic conditions.
We report this case to alert physicians that they should be vigilant for signs of abdominal thromboembolic
complications in patients suffering from COVID-19}