Basukala Sunil, Tamang Ayush, Bhusal Ujwal, Sharma Shriya, Gurung Samundra
Department of Surgery, Shree Birendra Hospital (SBH), Kathmandu, Nepal.
College of Medicine, Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal.
Int J Surg Case Rep. 2022 Oct;99:107703. doi: 10.1016/j.ijscr.2022.107703. Epub 2022 Sep 27.
The incidence of acute mesenteric ischemia (AMI) among critically ill COVID-19 patients has been reported ranging from 3.8 to 4 %.
A 57-year-old female presented with acute abdomen for last three days and tested positive for COVID-19. Abdominal X-ray showed prominent dilated small bowel loops with multiple air fluid levels, and absence of a completely visible colon. She underwent emergency laparotomy where blackish gangrenous bowel loops were seen and resected.
CECT scan in over half of the AMI patients may show patent mesenteric vessels. However, such patency of mesenteric vessels should not rule out the possibility of AMI in cases of COVID-19 with prominent GI signs and symptoms, especially those admitted in ICU.
AMI is a life-threatening complication that may occur in COVID-19 patients. It should be suspected in COVID-19 patients complaining of severe abdominal pain in addition to pulmonary symptoms.
据报道，危重症COVID-19患者中急性肠系膜缺血（AMI）的发生率为3.8%至4%。
一名57岁女性因急性腹痛就诊，病程已持续三天，COVID-19检测呈阳性。腹部X线显示小肠肠袢明显扩张，有多个气液平面，未见完整可见的结肠。她接受了急诊剖腹手术，术中可见黑色坏疽性肠袢并予以切除。
超过半数的AMI患者CT血管造影（CECT）扫描可能显示肠系膜血管通畅。然而，对于有明显胃肠道体征和症状的COVID-19患者，尤其是入住重症监护病房（ICU）的患者，肠系膜血管的这种通畅情况不应排除AMI的可能性。
AMI是一种可能发生在COVID-19患者身上的危及生命的并发症。对于除肺部症状外还主诉严重腹痛的COVID-19患者，应怀疑有AMI。
