Acute mesenteric arterial thrombosis in severe SARS-Co-2 pat
This is a 73-year-old male patient, with a relevant history: smoking 20 cigarettes a day, occasional alcoholism to drunkenness. Recently diagnosed diabetes mellitus and hypertension, allergy to paracetamol. No family history of hypertension or diabetes mellitus, no known genetic history, no previous surgeries. He begins with moderate to severe respiratory distress, fever, and general malaise of 7 days of evolution, he is taken to a hospital, where a rapid test is performed with a positive result for SARS CoV-2 (IgM +, IgG +), they begin management with oxygen and steroids, at that time the patient was not given anticoagulation. On day 7 of hospital stay, she presented severe abdominal pain, nausea and fecal emesis, fever of 39.5 °C, and peritoneal irritation, an abdominal X-ray was performed in a standing position where distention of intestinal loops, inter-loop edema, intestinal pneumatosis is observed reasons for being referred to a third-level center.

A patient is received in poor general condition with data on a frank acute abdomen, with radiographic data already commented, admission tests hemoglobin 15 g/dl, leukocytes 17 thousand/cm3, platelets 120 thousand/cm3, procalciton of 26 ng/ml, D-dimer less than 5000 ng/ml. With high suspicion of intestinal ischemia, the authors, as a surgical team, decided to take the patient to explore laparotomy, explain to the patient and his relatives the risks and benefits of the procedure, the patient accepts and signs the consent of information from the surgery.

During the surgery, surgeons resect a 3-meter segment of the small intestine (terminal jejunum and proximal ileon), perform end-to-end anastomosis leaving a 1.5 m segment of the small intestine, the purulent collection is drained in the pelvis, placement of drains, ending the procedure. After surgery initiate management with antibiotics, analgesic, and enoxaparin (60 mg/0.6 ml) a dose every 24 h. The patient goes to intensive therapy with mechanical ventilation, after 5 days he presents atrial fibrillation which is treated with amiodarone.

On day 10 postoperatively, he presented slight leakage of intestinal fluid due to the closure of the midline, it was decided to manage an intestinal fistula with conservative treatment and parenteral nutrition, closing this at 3 weeks. Five days after the intervention, the pathology report reports data on ischemia and necrosis of the intestinal mucosa in a 3-meters segment of the small intestine. The patient presented significant deterioration in lung function, subsequently multi-organ failure, dying 30 days after the procedure.

Source:https://www.sciencedirect.com/science/article/pii/S2210261221008099
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