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.