Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200105
Jornal Vascular Brasileiro
Case Report

Late mesenteric ischemia after Sars-Cov-2 infection: case report

Isquemia mesentérica tardia após infecção por Sars-Cov-2: relato de caso

Vilson Sovio Oliveira de Macedo; Geterson Bezerra Moreira; Ana Cristina Fiuza de Albuquerque; Sebastião Carlos de Sousa Oliveira; Mateus Aragão Esmeraldo; Francisco Cesar Barroso Barbosa

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Abstract

Abstract: The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of COVID-19, complaining of an initially insidious epigastric pain that had progressed to severe pain radiating to the interscapular vertebral region, with hyporexia and episodes of projectile vomiting, with no nausea or fever. Laboratory tests revealed no signs of acute infection or pancreatic injury. Abdominal computed tomography showed dilated, fluid-filled small bowel loops with thickened walls. After clinical treatment, the patient developed persistent abdominal pain. An exploratory laparotomy was performed, finding two sites of small bowel stenosis, with no extrinsic cause, and signs of local ischemia and considerable distension of jejunal and ileal loops. After enterectomy and side-to-side enteroanastomosis, the patient recovered satisfactorily and was discharged with a prescription for oral anticoagulants for outpatient use.

Keywords

COVID-19, mesenteric ischemia, laparotomy, anticoagulants, thrombosis

Resumo

Resumo: O objetivo deste artigo é relatar o caso de um homem de 53 anos de idade, negro, sem comorbidades prévias, com diagnóstico confirmado de COVID-19 há 48 dias anteriores ao início do quadro de dor epigástrica insidiosa, que evoluiu para dor de forte intensidade que irradiava para região interescapulovertebral, associada a hiporexia e episódios de vômitos em jato, sem náuseas ou febre. Os exames laboratoriais não apresentavam sinais de infecção aguda ou lesão pancreática. A tomografia computadorizada do abdome mostrou alças do intestino delgado dilatadas, cheias de líquido e com paredes espessas. Após terapia de suporte, o paciente evoluiu com dor abdominal persistente. Foi realizada laparotomia exploratória, na qual foram encontrados dois sítios de estenose no intestino delgado sem causa extrínseca, ao lado de sinais de isquemia local e distensão importante das alças jejunais e ileais. Após enterectomia e enteroanastomose primária látero-lateral, o paciente evoluiu de forma satisfatória e recebeu alta hospitalar com prescrição de anticoagulantes orais para uso ambulatorial.
 

Palavras-chave

COVID-19, isquemia mesentérica, laparotomia, anticoagulantes, trombose

References

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Submitted date:
07/22/2020

Accepted date:
11/08/2020

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