key: cord-1016365-bq3slyqs
authors: Almeida, Ana; Baixauli, Jorge; Cienfuegos, Javier A.; Valentí, Víctor; Rotellar, Fernando
title: Concomitant aortic, inferior mesenteric artery thrombosis and sigmoid colon perforation in severe covid-19 disease
date: 2021-10-05
journal: Cir Esp
DOI: 10.1016/j.ciresp.2021.09.013
sha: 33c315d662738e2f494cc45f698458b2ad6a76dd
doc_id: 1016365
cord_uid: bq3slyqs

nan

The gastrointestinal thromboembolic complications of SARS-CoV-2 are associated with high mortality (32% -86%). We present the case of a patient with severe COVID-19 who developed infrarenal thrombosis and perforation of the colon.

A 79-year-old male was transferred to our center with severe bilateral pneumonia due to SARS-CoV-2 (COVID-19) and required mechanical ventilations. He had a history of acute myocardial infarction, hypertension, obesity (BMI 28), dyslipidemia and chronic obstructive pulmonary disease. On admission his ASA (American Society of Anesthesiology) score was IV. Blood analyses revealed hemoglobin 11.7 g/dL (Reference Range 13.6-17.0), leucocytes 16.9 x 10 9 /L (RR 6-10) with 91% neutrophils, platelets 251 Secondly, direct injury of the mucosa of the intestine and colon has been reported by SARS-CoV-2, which is facilitated by the presence of abundant ACE2 and TMPRSS-2 membrane receptors in the intestine and colon 6, 7 . The cell damage and necrosis would induce the innate immune response (the so-called "cytokine storm") secondary to the release of damage-associated molecular patterns (DAMPS) and pathogen-associated molecular patterns (PAMPS), thus causing the synthesis of proinflammatory and prothrombotic cytokines 1, 5, 8 .

Finally, it cannot be ruled out that the perforation of the sigmoid colon might be due to the perforation of a diverticulum secondary to occlusive intestinal ischemia or nonocclusive ischemia resulting from abnormalities in perfusion 9 .

In spite of antithrombotic prophylaxis with LMWH and the recommendations of more than 70 scientific societies on antithrombotic prevention, in severe COVID-19 very often J o u r n a l P r e -p r o o f oligo-symptomatic (pauci-symptomatic) thromboembolic complications occur which require early diagnosis and treatment given their high morbidity and mortality 10 . 

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