key: cord-0907902-4o69734c authors: Singh, Balraj; Kaur, Parminder title: COVID-19 and acute mesenteric ischemia: A review of literature date: 2020-11-12 journal: Hematol Transfus Cell Ther DOI: 10.1016/j.htct.2020.10.959 sha: 7acca7a54c5d9ea2a5f047da4982cb0387891464 doc_id: 907902 cord_uid: 4o69734c nan (severe acute respiratory syndrome coronavirus 2) has caused global health crisis. Initially considered a respiratory tract pathogen, it can cause multiple organ dysfunction. It has also been described to predispose to venous and arterial thromboembolism; however, limited published data is available Q5 regarding mesenteric thrombosis COVID-19. We conducted a rapid review of current scientific literature available in PubMed to identify cases of AMI in in COVID-19 patients-total of 13 cases were found. We delineated clinical characteristics and outcome in these patients. Clinicians should be aware of the life-threatening situation in COVID-19 patients. A novel coronavirus termed as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been the causative agent of a pandemic that originated in Wuhan China in December 2019. Coronavirus disease-2019 (COVID-19) can present with a wide variety of complications during infection. For optimal management of these patients, understanding of various systemic manifestations and complications of SARS-CoV2 is vital. Although in COVID-19 respiratory symptoms predominate, both arterial and venous thrombosis can occur with COVID-19. Arterial thrombosis reported so far include stroke, acute limb ischemia, acute mesenteric ischemia and acute coronary syndrome. [1] [2] [3] [4] Limited literature is available regarding acute mesenteric ischemia (AMI). We did an extensive literature review on COVID-19 associated mesenteric thrombosis. We searched PubMed for this literature review using search terms 'COVID-19 and mesenteric thrombosis', 'COVID-19 and mesenteric ischemia', and 'COVID-19 and bowel ischemia'. All the case reports who had COVID-19 associated mesenteric thrombosis so far is reviewed, and relevant data abstracted from these studies in Table 1 . COVID-19 diagnosis was made by PCR assay except in one patient it was negative (suspected . Clinical characteristics of the COVID-19 patients with AMI are summarized in Table 1 . [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] The median age of the patient was 56 years (range 9-79 years). We found total of 13 patients-9 were male, 3 female and for 1 patient sex was not reported. AMI can occur as a presenting feature or a late complication of COVID-19 during hospitalization (median 7 days). 6 patients had pre-existing comorbidities while 7 patients had none. The pre-existing conditions reported were hypertension, diabetes, obesity, obstructive sleep apnea, anxiety, idiopathic medullar aplasia, chronic bronchitis, essential thrombocytosis, and cardiac transplantation. Presenting symptoms were nausea, vomiting, abdominal pain, diarrhea, fever, cough, shortness of breath, eructation, pain in throat and stroke. The diagnosis of AMI was made by contrast enhanced computed tomography. 4 patients had concurrent thrombosis at other sites -case 3 had stroke, case 7 had portal and mesenteric vein thrombosis, case 8 had splenic and renal infarcts and case 11 had superior mesenteric and portal vein thrombosis. 10 patients had surgery, 2 patients had conservative management and 1 was started on therapeutic anticoagulation with heparin. Out of 13 patients, 4 patients died. Acute mesenteric ischemia is a rare abdominal emergency and is associated with high rates of morbidity and mortality. Prompt diagnosis requires a high index of suspicion and early contrast computed tomography imaging. The exact pathological mechanism leading to the complication of AMI in COVID-19 is not well understood at present, possibilities include -direct invasion of bowel tissue by the virus given expression of angiotensin converting enzyme 2 on enterocytes, the target receptor for SAR-Cov-2 or viral infection of the endothelial cell leading to diffuse endothelial inflammation or increased procoagulant factors like factor VIII, von Willebrand factor, fibrinogen or virus induced cytokine storm leading to coagulation and fibrinolysis activation. [16] [17] [18] Additional explanations for the hypercoagulability may be the presence of high numbers of prothrombotic circulating microvesicles which are cytoplasmic microparticles stemming from platelets or monocytes and Neutrophil extracellular traps (NETs) released from activated neutrophils, constitute a mixture of nucleic DNA, histones and nucleosomes. 18 Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure -gastrointestinal decom- Q6 r e f e r e n c e s Acute upper limb ischemia in a patient with COVID-19 The looming storm: Blood and cytokines in COVID-19 COVID-19 Presenting as Acute Limb Ischaemia Covid-19 Presenting as Acute Limb Ischemia Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2 Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19 SARS-CoV-2-related Hypercoagulable State Leading to Ischemic Enteritis Secondary to Superior Mesenteric Artery Thrombosis Arterial Mesenteric Thrombosis as a Complication of SARS-CoV-2 Infection Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19 Arterial and venous abdominal thrombosis in a 79-year-old woman with COVID-19 pneumonia Arterial thrombotic complications in COVID-19 patients Intestinal ischemia secondary to Covid-19 Small bowel ischemia and SARS-CoV-2 infection: an underdiagnosed distinct clinical entity Bowel ischemia in a suspected coronavirus disease (COVID-19) patient Acute Mesenteric Ischemia in Severe Coronavirus-19 (COVID-19): Possible Mechanisms and Diagnostic Pathway Endothelial cell infection and endotheliitis in COVID-19 Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis Arterial thrombotic complications in COVID-19 patients