Acute mesenteric ischemia and COVID-19: an integrative review of the literature

SILVA, JULYANNE TEREZA CORDEIRO; FONSECA NETO, OLIVAL CIRILO LUCENA DA

doi:10.1590/0100-6991e-20233334-en

Acessibilidade / Reportar erro

Brasil

Revista do Colégio Brasileiro de Cirurgiões

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev. Col. Bras. Cir. 50 • 2023 • https://doi.org/10.1590/0100-6991e-20233334-en copy

Acute mesenteric ischemia and COVID-19: an integrative review of the literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) has spread rapidly around the world after the first cases were reported in December 2019 in China. Despite the prevention of the symptoms presented, extrapulmonary manifestations were identified. In particular, there was an increase in cases of Acute Mesenteric Ischemia (AMI), raising its incidence to 1.9%-3.8% in infected patients. The aim of this study was to investigate the existence of an association between IMA and COVID-19 through the literature. An Integrative Literature Review was carried out. The research question was “mesenteric ischemia in patients with COVID-19: coincidence or association?”. After searching the database and applying the inclusion and exclusion criteria, 44 were selected for analysis. COVID-19 was confirmed by RT-PCR and imaging tests, gastrointestinal manifestations, alterations and primarily tomographic imaging findings were identified. Most patients were accelerated to laparotomy. As explanations include direct endothelial and injury by the binding of the ACE-2 virus, between hyperinflammation and hypercoagulability, dysregulation of the renin-angiotensin-aldosterone system and factors associated with the severity of the virus. IMA is an emergency with high associated morbidity and mortality, these cases may be a consequence mainly of the thromboinflammatory mechanism associated with SARS-CoV-2. An early diagnosis, diagnosis and diagnoses are crucial to clinical treatment; an assessment regime should be considered in accordance with current evidence and guidelines.

Keywords:
Mesenteric Ischemia; COVID-19; SARS-CoV-2

1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
Azouz et al.⁵⁰50 Azouz E, Yang S, Monnier-Cholley L, Arrivé L. Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19. Intensive Care Med. 2020;46(7):1464-5. doi: 10.1007/s00134-020-06079-2. https://doi.org/10.1007/s00134-020-06079...	France	1	56	Abdominal pain, vomiting	Thrombosis in the aortic arch and SMA; dilation and signs of small bowel ischemia	Thrombectomy and laparotomy with resection of the ischemic bowel	NR
Norsa et al.²³23 Norsa L, Valle C, Morotti D, Bonaffini PA, Indriolo A, Sonzogni A. Intestinal ischemia in the COVID-19 era. Dig Liver Dis. 2020 Oct;52(10):1090-1. doi: 10.1016/j.dld.2020.05.030. https://doi.org/10.1016/j.dld.2020.05.03...	Italy	1	62	Abdominal pain, vomiting	Thrombosis in the inferior vena cava and SMV; dilation, pneumatosis and signs of ischemia in the small intestine	Laparotomy with resection of the ischemic bowel	Death
Singh et al.⁵⁷57 Singh B, Mechineni A, Kaur P, Ajdir N, Maroules M, Bikkina FS and M. Acute Intestinal Ischemia in a Patient with COVID-19 Infection. Korean J Gastroenterol. 2020;76(3):164-6. doi: 10.4166/kjg.2020.76.3.164. https://doi.org/10.4166/kjg.2020.76.3.16...	USA	1	82	Abdominal distention and sensitivity	Dilation and pneumatosis in the ascending colon and cecum (without visualization of vessels due to the absence of contrast in the exam)	Laparotomy with resection of the necrotic bowel and ileostomy	Discharge
Sehhat et al.²⁴24 Sehhat S, Talebzadeh H, Hakamifard A, Melali H, Shabib S, Rahmati A, et al. Acute Mesenteric Ischemia in a Patient with COVID-19: A Case Report. Arch Iran Med. 2020;23(9):639-43. doi: 10.34172/aim.2020.77. https://doi.org/10.34172/aim.2020.77...	Will	1	77	Abdominal pain and tenderness	Dilation of loops and thickening of the wall of the small intestine (without visualization of vessels due to the absence of contrast in the exam)	At laparotomy, more than 80cm of ischemic bowel was resected	Death
Rodriguez-Nakamura et al.⁵¹51 Rodriguez-Nakamura RM, Gonzalez-Calatayud M, Martinez AR. Acute mesenteric thrombosis in two patients with COVID-19. Two cases report and literature review. Int J Surg Case Rep.;76:409-14. doi: 10.1016/j.ijscr.2020.10.040.	Mexico	2	45	Abdominal pain, nausea	Thrombosis in the SMA, signs of ischemia in the distal ileum and cecum	Laparotomy with resection of necrotic bowel	Discharge
			42	Abdominal pain and distention	Thrombosis of the portal and mesenteric veins; mesenteric gas	Laparotomy with resection of necrotic loops, omentectomy and lavage of the cavity due to jejunal perforation	Death
Ucpinar et al.⁵⁸58 Ucpinar BA U, Sahin C. Superior Mesenteric Artery Thrombosis in a Patient with COVID-19: A Unique Presentation. J Coll Physicians Surg Pak. 2020;30(10):S112-4. doi: 10.29271/jcpsp.2020.supp2.112. https://doi.org/10.29271/jcpsp.2020.supp...	Turkey	1	82	Abdominal pain and distention; signs of peritonitis	SMA thrombosis; intestinal dilation and pneumatosis; portal and mesenteric venous gas	Died during the preoperative period	Death
Dinoto et al.⁵⁹59 Dinoto E, Ferlito F, Marca MA, Mirabella D, Bajardi G, Pecoraro F. Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report. Int J Surg Case Rep. 2021;84:106105. doi: 10.1016/j.ijscr.2021.106105. https://doi.org/10.1016/j.ijscr.2021.106...	Italy	1	84	Abdominal pain and distention; signs of acute abdomen; absent peristalsis	SMA thrombosis; absence of wall enhancement	Endovascular thrombectomy	Death
1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
Karna et al.²⁰20 Karna ST, Panda R, Maurya AP, Kumari S. Superior Mesenteric Artery Thrombosis in COVID-19 Pneumonia: an Underestimated Diagnosis-First Case Report in Asia. Indian J Surg. 2020;82(6):1235-7. doi: 10.1007/s12262-020-02638-5. https://doi.org/10.1007/s12262-020-02638...	India	1	61	Abdominal pain and distention; fecaloid vomit	SMA thrombosis with occlusion of the distal ileocolic branch; bowel dilation	Laparotomy with resection of the necrotic bowel and ileostomy	Death
Amaravathi et al.²⁵25 Amaravathi U, Balamurugan N, Pillai VM, Ayyan SM. Superior Mesenteric Arterial and Venous Thrombosis in COVID-19. J Emerg Med. 2021;60(5):e103-e107. doi: 10.1016/j.jemermed.2020.12.016. https://doi.org/10.1016/j.jemermed.2020....	India	1	45	Abdominal pain	Simultaneous thrombosis of SMA and SMV	Emergency laparotomy and thrombectomy of the SMA; relaparotomy after 48 hours with resection of the necrotic bowel and jejunostomy	NR
Fan et al.²⁶26 Fan BE, Chang CCR, Teo CHY, Yap ES. COVID-19 Coagulopathy with Superior Mesenteric Vein Thrombosis Complicated by an Ischaemic Bowel. Hamostaseologie. 2020;40(05):592-3. doi: 10.1055/a-1232-7446. https://doi.org/10.1055/a-1232-7446...	Singapore	1	30	Abdominal pain, vomiting	SMV thrombosis; bowel dilation and obstruction	Laparotomy with resection of necrotic bowel	Discharge
Nasseh et al.²⁷27 Nasseh S, Trabelsi MM, Oueslati A, Haloui N, Jerraya H, Nouira R. COVID-19 and gastrointestinal symptoms: A case report of a Mesenteric Large vessel obstruction. Clin Case Rep. 2021;9(6):e04235. doi: 10.1002/ccr3.4235. https://doi.org/10.1002/ccr3.4235...	Tunisia	1	68	Abdominal pain, diarrhea	Thickened intestinal wall; terminal obstruction of the ileocolic artery	Unfractionated Heparin and laparoscopy after 3 days	Discharge
Mahruqi et al.²⁸28 Mahruqi GA, Stephen E, Abdelhedy I, Wahaibi KA. Our early experience with mesenteric ischemia in COVID-19 positive patients. Ann Vasc Surg. 2021;73:129-132. doi: 10.1016/j.avsg.2021.01.064. https://doi.org/10.1016/j.avsg.2021.01.0...	Oman	2	51	NR	Non-Occlusive Mesenteric Ischemia; signs of intestinal hypoperfusion;	Laparotomia foi planejada, mas houve piora clínica e familiares recusaram intervenção cirúrgica	Óbito
			51	Abdominal pain; signs of peritonitis	SMA thrombosis; absence of wall enhancement	Emergency laparotomy with necrotic bowel resection and SMA thrombectomy and 2 relaparotomies at 24h intervals with final jejuno-colic anastomosis	Discharge
Chiu et al.⁶⁰60 Chiu CY, Sarwal A, Mon AM, Tan YE, Shah V. Gastrointestinal: COVID-19 related ischemic bowel disease. J Gastroenterol Hepatol. 2021;36(4):850. doi: 10.1111/jgh.15254. https://doi.org/10.1111/jgh.15254...	USA	1	49	Abdominal pain; hematemesis and melena	Distended proximal jejunum with mural thickening	Laparotomy with resection of ischemic bowel	NR
Krothapalli et al.¹⁰10 Krothapalli N, Jacob J. A Rare Case of Acute Mesenteric Ischemia in the Setting of COVID-19 Infection. Cureus. 2021;13(3):e14174. doi: 10.7759/cureus.14174. https://doi.org/10.7759/cureus.14174...	USA	1	76	Diarrhea and nausea; abdominal pain and distention	SMA and Celiac Trunk thrombosis; intestinal dilation and pneumatosis; absence of wall enhancement	Not a candidate for surgical intervention due to clinical conditions and poor prognosis	Death
Estevez- Cerda et al.²⁹29 Estevez-Cerda SC, Saldaña-Rodríguez JA, Alam-Gidi AG, Riojas-Garza A, Rodarte-Shade M, Garza JV, et al. Complicaciones intestinales graves en pacientes SARS-CoV-2 recibiendo manejo protocolizado. Rev Gastroenterol Mex. 2021;86(4):378-86. doi: 10.1016/j.rgmx.2021.03.002. https://doi.org/10.1016/j.rgmx.2021.03.0...	Mexico	1	55	NR	SMA Thrombosis	Laparotomy with resection of the necrotic bowel and jejunostomy	Death
1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
Macedo et al.³⁰30 Macedo VSO de, Moreira GB, Albuquerque ACF de, Oliveira SC de S, Esmeraldo MA, Barbosa FCB. Late mesenteric ischemia after Sars-Cov-2 infection: case report. J Vasc Bras. 2021;20:e20200105. doi: 10.1590/1677-5449.200105. https://doi.org/10.1590/1677-5449.200105...	Brazil	1	53	Abdominal pain, vomiting, belching	Dilated bowel loops and walls thickened by edema; pervious mesenteric vessels	Laparotomy with resection of the ischemic, edematous intestine with zones of stenosis	Discharge
Bannazadeh et al.³¹31 Bannazadeh M, Tassiopoulos A, Koullias G. Acute superior mesenteric artery thrombosis seven days after discharge for novel coronavirus pneumonia (NCP). J Vasc Surg Cases Innov Tech. 20217(3):586-588. doi: 10.1016/j.jvscit.2020.12.002. https://doi.org/10.1016/j.jvscit.2020.12...	USA	1	55	Abdominal pain	SMA Thrombosis	Laparotomy with resection of the necrotic bowel and thrombectomy of the SMA	Discharge
Mir et al.³²32 Mir MZ, Mashhadi A, Jahantigh M, Seyedi SJ. Bowel necrosis associated with COVID-19 pneumonia: A report of two cases. Radiol Case Rep. 2021;16(4):819-23. doi: 10.1016/j.radcr.2021.01.043. https://doi.org/10.1016/j.radcr.2021.01....	Iran	2	59	Abdominal pain	Signs of intestinal ischemia and necrosis; perforation, thickened intestinal wall with pneumoperitoneum and free fluid; splenic infarction	Laparotomy revealed necrotic bowel, perforation, and generalized peritonitis.	Death
			60	Abdominal pain	Signs of intestinal ischemia and perforation; air-fluid level and intestinal pneumatosis; renal and splenic infarction	Laparotomy revealed perforation, necrosis of the cecum and ascending colon	Discharge
Aktokmakyan et al.⁵⁴54 Aktokmakyan TV, Tokocin M, Meric S, Celebi F. Is Mesenteric Ischemia In COVID-19 Patients A Surprise? Surg Innov. 2021;28(2):236-238. doi: 10.1177/1553350620962892. https://doi.org/10.1177/1553350620962892...	Turkey	5	61 average	NR	NR	All underwent emergency surgery with a diagnosis of mesenteric ischemia	4/5 Discharge 1/5 Death
Roquetaillade et al.⁵⁵55 Roquetaillade C de, Chousterman BG, Tomasoni D, Zeitouni M, Houdart E, Guedon A, et al. Unusual arterial thrombotic events in Covid-19 patients. Int J Cardiol. 2021;323:281-4. doi: 10.1016/j.ijcard.2020.08.103. https://doi.org/10.1016/j.ijcard.2020.08...	France, Italy	1	62 media	NR	NR	NR	Death
Moheb et al.⁵⁶56 Moheb M el, Naar L, Christensen MA, Kapoen C, Maurer LR, Farhat M, et al. Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19. JAMA. 2020;324(18):1899-901. doi: 10.1001/jama.2020.19400. https://doi.org/10.1001/jama.2020.19400...	USA	4	60,5 media	NR	NR	Three of the 4 patients underwent surgery	NR
English et al.³³33 English W, Banerjee S. Coagulopathy and mesenteric ischaemia in severe SARS-CoV-2 infection. ANZ J Surg. 2020;90(9):1826. doi: 10.1111/ans.16151. https://doi.org/10.1111/ans.16151...	England	1	40	Abdominal distension	Hypoperfusion of the small intestine; intestinal pneumatosis	Emergency laparotomy with resection of the ischemic bowel; closure of the abdominal wall after 48h	NR
Pang et al.³⁴34 Pang JHQ, Tang JH, Eugene-Fan B, Lee CL, Low JK. A Peculiar Case of Small Bowel Stricture in a Coronavirus Disease 2019 Patient with Congenital Adhesion Band and Superior Mesenteric Vein Thrombosis. Ann Vasc Surg. 2021;70:286-9. doi: 10.1016/j.avsg.2020.08.084. https://doi.org/10.1016/j.avsg.2020.08.0...	Singapore	1	30	Abdominal pain, vomiting	SMV thrombosis, intestinal wall thickening	Conservative management on the 1st admission with LMWH; laparotomy on the 2^nd admission	Discharge
Ammar et al.³⁵35 Ammar AS, Naqi SA, Ashraf M, Saleem M, Raza HA, Haider U. A rare case report of short bowel anastomosis after acute mesenteric ischaemia in Covid-19 postive patient. J Pak Med Assoc. 2022;72(6):1222-4. doi: 10.47391/JPMA.3961. https://doi.org/10.47391/JPMA.3961...	Pakistan	1	55	Abdominal pain and tenderness, absence of BS	Multiple air-fluid levels	Laparotomy with resection of the gangrenous bowel	Discharge
1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
Bianco et al.³⁶36 Bianco F, Ranieri AJ, Paterniti G, Pata F, Gallo G. Acute intestinal ischemia in a patient with COVID-19. Tech Coloproctol. 2020;24(11):1217-8. doi: 10.1007/s10151-020-02255-0. https://doi.org/10.1007/s10151-020-02255...	Italy	1	59	Abdominal pain, nausea	Air-fluid levels, mesenteric edema, ascites	Laparotomy with resection of the ischemic bowel	Death
Romero et al.⁷7 Romero MDCV, Cárdenas AM, Fuentes AB, Barragán AAS, Gómez DBS, Jiménez MT. Acute mesenteric arterial thrombosis in severe SARS-Co-2 patient: A case report and literature review. Int J Surg Case Rep. 2021;86:106307. doi: 10.1016/j.ijscr.2021.106307. https://doi.org/10.1016/j.ijscr.2021.106...	Mexico	1	73	Abdominal pain, nausea and vomiting, signs of peritonitis	Edema and distention of intestinal loops, intestinal pneumatosis,	Laparotomy with resection of the ischemic bowel	Death
Sevella et al.³⁷37 Sevella P, Rallabhandi SS, Jahagirdar V, Kankanala SR, Ginnaram AR, Rama K. Acute Mesenteric Ischemia as an Early Complication of COVID-19. Cureus. 2021;13(9):e18082. doi: 10.7759/cureus.18082. https://doi.org/10.7759/cureus.18082...	India	1	44	Abdominal pain and distention, vomiting, constipation, absence of BS	Peritoneal thickening, signs of intestinal ischemia, absent peristalsis, moderate ascites	Laparotomy with resection of the gangrenous bowel	Death
Bagheripour³⁸38 Bagheripour MH, Zakeri MA. Acute Mesenteric Ischemia in a COVID-19 Patient: Delay in Referral and Recommendation for Surgery. Case Rep Gastrointest Med. 2021;2021:1999931. doi: 10.1155/2021/1999931. https://doi.org/10.1155/2021/1999931...	Iran	1	78	Abdominal pain, tenderness and distention, nausea and vomiting, constipation, absence of BS	Bowel dilation, air-fluid levels, ascites	Diagnostic laparotomy, no intervention performed due to gangrenous extension	Death
Chandrakar et al.⁸8 Chandrakar S, Sangadala P, Gupta M, Kumar DA, Agarwal A. Acute mesenteric ischemia in COVID-19: Case report and current understanding. Qatar Med J. 2022;2022(1):11. doi: 10.5339/qmj.2022.11. https://doi.org/10.5339/qmj.2022.11...	India	2	72	Abdominal pain, vomiting, constipation	Pneumatosis intestinalis, portal venous gas	Laparotomy with resection of gangrenous bowel	Discharge
			70	Abdominal pain, vomiting, constipation	Dilation of intestinal loops, ascites	Laparotomy with resection of gangrenous bowel	Death
Sukegawa et al.³⁹39 Sukegawa M, Nishiwada S, Terai T, Kuge H, Koyama F, Nakagawa K, et al. Acute superior mesenteric artery occlusion associated with COVID-19 pneumonia: a case report. Surg Case Rep. 2022;8(1):6. doi: 10.1186/s40792-022-01360-6. https://doi.org/10.1186/s40792-022-01360...	Japan	1	70	Abdominal pain	SMA thrombosis, signs of intestinal ischemia, right renal infarction	Laparotomy with resection of necrotic bowel	Discharge
Marsafi et al.⁴⁰40 Marsafi O, Ijim F, Elkourchi M, Chahbi Z, Adnor S, Wakrim S. Ischémie mésentérique aiguë veineuse chez un jeune sujet COVID-19 positif: à propos d'un cas. Pan Afr Med J. 2021;39:273. doi: 10.11604/pamj.2021.39.273.30454. https://doi.org/10.11604/pamj.2021.39.27...	Morocco	1	33	Abdominal pain and tenderness, absence of BS	Mesenteric, portal, and splenic thrombosis, intestinal wall thickening, submucosal edema, ascites, pneumatosis, and signs of intestinal ischemia	Therapeutic anticoagulation and laparotomy with resection of the ischemic bowel	Death
Costa et al.⁹9 Costa F, Nogueira L, Marques S, Torres L, Silva AF. An Improbable Thromboembolic Manifestation of COVID-19: A Case Report. Cureus. 2022;14(3):e23013. doi: 10.7759/cureus.23013. https://doi.org/10.7759/cureus.23013...	Portugal	1	75	Abdominal pain, vomiting, diarrhea	SMA thrombosis, bowel loop dilation	After 2 exploratory laparotomies, it was decided to maintain conservative treatment and proceeded to palliative care	NR
1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
Sarkardeh et al.⁵³53 Sarkardeh M, Meftah E, Mohammadzadeh N, Koushki J, Sadrzadeh Z. COVID-19 and Intestinal Ischemia: A Multicenter Case Series. Front Med (Lausanne). 2022;9879996. doi: 10.3389/fmed.2022.879996. https://doi.org/10.3389/fmed.2022.879996...	Iran	24	61,5 median	Abdominal pain	Pneumatosis and intestinal wall thickening, perforation, ascites, pneumoperitoneum	Resection and end-to-end anastomosis of the small intestine was the most common surgical intervention (46%). Terminal ileostomy was performed in 3 patients, Hartmann’s colostomy in 3 others, double-barrel ileostomy in 2 patients. Primary enterorrhaphy was performed in 2. Embolectomy was performed in 1 patient with SMA thrombosis. One patient did not receive any surgical repair due to necrotic extension. Another patient was treated clinically.	62.5% mortality
Hanif et al.⁶¹61 Hanif M, Ahmad Z, Khan AW, Naz S, Sundas F. COVID-19-Induced Mesenteric Thrombosis. Cureus. 2021;13(1):e12953. doi: 10.7759/cureus.12953. https://doi.org/10.7759/cureus.12953...	Pakistan	1	20	Abdominal pain, tenderness, and distention	Various levels of fluids	Laparotomy with resection of gangrenous bowel	Discharge
Asghari et al.⁴¹41 Asghari A, Adeli SH, Vafaeimanesh J, Bagheri H, Riahi M, Mirdamadi M. Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report. Middle East J Dig Dis. 2021;13(1):75-9. doi: 10.34172/mejdd.2021.208. https://doi.org/10.34172/mejdd.2021.208...	Iran	1	51	Abdominal pain, tenderness and distention, nausea	Dilation of bowel loops	Emergency laparotomy on 1^st admission, 2 relaparotomies on 2^nd admission, with resection of necrotic bowel	Death
Gupta et al.⁶²62 Gupta A, Sharma O, Srikanth K, Mishra R, Tandon A, Rajput D. Review of Mesenteric Ischemia in COVID-19 Patients. Indian J Surg. 2022;1-9. doi: 10.1007/s12262-022-03364-w. https://doi.org/10.1007/s12262-022-03364...	India	1	55	Abdominal pain, vomiting	SMA Thrombosis	Laparotomy with resection of the gangrenous bowel	Death
Hussein et al.⁴³43 Hussein MH, Alabdaljabar MS, Alfagyh N, Badran M, Alamiri K. Splanchnic venous thrombosis in a nephrotic patient following COVID-19 infection: a case report. BMC Nephrol. 2021;22(1):420. doi: 10.1186/s12882-021-02643-0. https://doi.org/10.1186/s12882-021-02643...	Saudi Arabia	1	20	Abdominal pain, hematochezia	Mesenteric, portal, splenic, and right hepatic venous thrombosis, intestinal congestion, ascites, pneumatosis, and pneumoperitoneum	At first, mechanical thrombectomy, thrombolytics and anticoagulation. Subsequently, laparotomy with resection of the necrotic intestine.	Discharge
1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
Alemán et al.⁴⁴44 Alemán W, Cevallos LC. Subacute mesenteric venous thrombosis secondary to COVID-19: A late thrombotic complication in a nonsevere patient. Radiol Case Rep. 2021;16(4):899-902. doi: 10.1016/j.radcr.2021.01.039. https://doi.org/10.1016/j.radcr.2021.01....	Ecuador	1	44	Abdominal pain and tenderness	SMV, portal and splenic vein thrombosis	Anticoagulation with LMWH and pain control. He continued with oral anticoagulation for 6 months.	Discharge
Cheung et al.⁴⁵45 Cheung S, Quiwa JC, Pillai A, Onwu C, Tharayil ZJ, Gupta R. Superior Mesenteric Artery Thrombosis and Acute Intestinal Ischemia as a Consequence of COVID-19 Infection. Am J Case Rep. 2020;21:e925753-1. doi: 10.12659/AJCR.925753. https://doi.org/10.12659/AJCR.925753...	USA	1	55	Abdominal pain and tenderness, nausea and vomiting, diarrhea, decreased BS	SMA Thrombosis	Therapeutic anticoagulation, SMA thrombectomy, and laparotomy with resection of necrotic bowel	NR
Nada et al.⁴⁶46 Nada A, Shabana A, Elsaadany A, Abdelrahman A, Gaballah AH. Superior mesenteric artery thrombosis and small bowel necrosis: An uncommon thromboembolic manifestation in COVID-19 pneumonia. Radiol Case Rep. 2022;17(3):821-4. doi: 10.1016/j.radcr.2021.11.069. https://doi.org/10.1016/j.radcr.2021.11....	USA	1	49	Abdominal pain, signs of peritonitis	SMA thrombosis, signs of intestinal ischemia and pneumatosis, pneumoperitoneum, renal infarction	Conservative treatment with LMWH due to advanced intestinal necrosis	Death
Alali et al.⁴⁷47 Alali AA, Baqais MO, Albishi FM, Alkhamis AI, Alshehri YA, Amri KF, et al. Superior Mesenteric Artery Thrombosis Following Severe COVID-19 Pneumonia. Cureus. 2021;13(11):e19954. doi: 10.7759/cureus.19954. https://doi.org/10.7759/cureus.19954...	Saudi Arabia	1	35	Abdominal pain and tenderness, vomiting	SMA Thrombosis	Therapeutic anticoagulation, later laparotomy	Discharge
Khaleghi et al.⁴⁸48 Khaleghi M, Aziz-Ahari A, Rezaeian N, Asadian S, Mounesi Sohi A, Motamedi O, et al. The Valuable Role of Imaging Modalities in the Diagnosis of the Uncommon Presentations of COVID-19: An Educative Case Series. Case Rep Med. 2021;2021:7213627. doi: 10.1155/2021/7213627. https://doi.org/10.1155/2021/7213627...	Iran	1	54	Abdominal pain, tenderness and distention, nausea and vomiting	SMA thrombosis, bowel loop dilation	Laparotomy with resection of necrotic bowel, relaparotomy to assess abnormalities	NR
Posada-Arango et al.⁴⁹49 Posada-Arango AM, García-Madrigal J, Echeverri-Isaza S, Alberto-Castrillón G, Martínez D, Gómez AC, et al. Thrombosis in abdominal vessels associated with COVID-19 Infection: A report of three cases. Radiol Case Rep. 2021;16(10):3044-50. doi: 10.1016/j.radcr.2021.07.032. https://doi.org/10.1016/j.radcr.2021.07....	Peru	3	62	Abdominal pain, vomiting	air-fluid levels	At first anticoagulation with UFH, later laparotomy without the possibility of intestinal resection due to necrotic extension	NR
			22	Abdominal pain	SMV thrombosis	Anticoagulation, analgesia, and antibiotic therapy	NR
			65	Abdominal pain and tenderness, hyporexia	Left jejunal artery thrombosis, dilation and signs of intestinal ischemia, splenic infarction	Laparotomy with resection of necrotic bowel	NR
Fransvea et al.⁵²52 Fransvea P, Costa G, Pepe G, la Greca A, Magalini S, Puccioni C, et al. Acute intestinal ischemia in patients with COVID-19: single-centre experience and literature review. Eur Rev Med Pharmacol Sci. 2022;26(4):1414-29. doi: 10.26355/eurrev_202202_28135. https://doi.org/10.26355/eurrev_202202_2...	Italy	2	72±7,1 Average	Abdominal pain and distention, nausea and vomiting	SMA thrombosis, signs of intestinal ischemia	Laparotomy with resection of the ischemic bowel, relaparotomy after 48 hours for anastomosis and closure of the abdominal wall	Discharge
1^st Author	Country	n	Age	Gastrointestinal Manifestations	Imaging findings	Conduct	Outcome
					SMA thrombosis, signs of intestinal ischemia, splenic and hepatic infarction	Exploratory laparotomy without possibility of intestinal resection due to advanced ischemia	Death

Colégio Brasileiro de Cirurgiões Rua Visconde de Silva, 52 - 3º andar, 22271- 090 Rio de Janeiro - RJ, Tel.: +55 21 2138-0659, Fax: (55 21) 2286-2595 - Rio de Janeiro - RJ - Brazil
E-mail: revista@cbc.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing address: Julyanne Tereza Cordeiro Silva E-mail: julyannecordeiro@gmail.com