COVID-19 induced mesenteric venous infarction with small bowel obstruction
Diagnosis almost certain
Presentation
Signs of small bowel obstruction in a patient with COVID-19 pneumonia (PCR positive).
Patient Data
Age: 65 years
Gender: Female
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CT scan demonstrates:
- Bilateral multifocal ground-glass opacities of peripheral distribution are seen in both lungs in keeping with a COVID-19 pneumonia
- distended small bowel loops with fluid-filled and faces sign, mainly of the distal jejunum and ileum with edematous enhanced wall especially the terminal ileum. Marked edema of the adjacent mesentery with moderate free fluid in the peritoneal cavity in keeping with a small bowel infarction
- occlusion of a branch of the ileocolic vein which appears dilated with intraluminal filling defect. The superior mesenteric artery is patent
Other findings:
- Sliding hiatus hernia
- cholelithiasis (confirmed by ultrasound, not shown)
- ectopic left kidney in the upper pelvic region
Case Discussion
CT features of small bowel ischemia due to mesenteric vein thrombosis with a small bowel obstruction in a patient with COVID-19 pneumonia.
The diagnosis of acute mesenteric ischemia should be suspected in any COVID-19 patient with acute gastrointestinal symptoms because we currently know that COVID-19 is a disease with a tendency to a hypercoagulable state and vascular thrombosis 1,2.
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