Discussion
This case of mesenteric ischemia in a patient with COVID 19, with no risk of thrombogenesis highlights the variability of symptoms of this disease.
To our knowledge, we are among the first who described a case of mesenteric large vessel obstruction associated to the Corona virus worldwide.
CT scan is known to be one of diagnostic means of COVID-19. Besides bilateral multiple ground glass opacities at lung bases in chest CT scan, abdominal imaging findings such as small and large bowel wall thickening, fluid-filled colon, pneumatosis intestinalis, pneumoperitoneum, intussusception and ascites have also been reported[3] .
Thrombogenesis in COVID-19 has also been described in few cases and it can be attributed to the direct and indirect cytotoxic effects of the SARS-CoV-2 virus on vascular endothelium, due to the corona virus’s affinity to the ACE-2 receptor on endothelial surfaces. In fact, endothelial dysfunction is a principal determinant of micro vascular dysfunction by shifting the vascular equilibrium towards more vasoconstriction with subsequent organ ischemia, inflammation with associated tissue edema, and a pro coagulant state [4].
In our case, this phenomenon touched a large vessel rather than capillaries, which is why it was treatable by Heparine.
To reduce the contamination rate properly, it is imperative to recognize SARS-CoV-2-positive patients rapidly in order to deliver adapted care and to isolate them from the rest of the patients until their recovery. Early suspicion is also necessary to protect healthcare workers, who should use personal protective equipment in such cases.
It implies that, as long as the COVID-19 pandemic is ongoing, patients presenting with non-explained gastrointestinal symptoms should be managed as potentially infected and COVID-19 diagnostic tests should be performed in time such is our case.