P1259 - Acute Mesenteric Ischemia in COVID-19 Patients: A Case Series

Sanjay Kumar, FACG, Sunil Kasturi, MD, DM, Sandesh Sharma, MS, Naveen Tmu, MD, DM, Neetu kumar, MD, Vinod Narkhede, MD, Kshitij Kumar, MBBS
Bhopal Institute of Gastroenterology, Bhopal, Madhya Pradesh, India

Introduction: COVID-19 is known to produce a prothrombotic state resulting in various complications. Mesentric ischemia (MI) is not common;ly suspected. MI needs prompt diagnosis and aggressive management. We evaluated our patients of MI during second wave of COVID who presented to a GI centre in central India.

Methods: This was a retrospective single center case series of 10 patients presenting with MI in covid-19 between May 2021 to July 2021. All patients admitted with signs and symptoms of MI and who had a history of covid infection were included in study.Their diagnosis, course in hospital, surgical procedures performed and final outcome was assessed.



Results: Eight of the 10 patients were males.Seven (70%) had SMA thrombosis, two patients had celiac and renal vessles involved and one had IMA thrombosis. Two patients were already on anticoagulants (aspirin/clopidogrel) but still developed MI. Most of them on presentation had abdominal symptoms such as pain abdomen, distention, vomiting etc. They were evaluated by D Dimer, CRP, Procalcitonin, CECT abdomen with angio. Mean leukocyte, neutrophil, and platelet levels were within the normal range, lymphocyte counts were low. C-Reactive Protein was raised in all patients. The mean levels of INR, Platelet, and APTT were raised. While D-dimer levels were close to the upper limit; fibrinogen levels were raised in all patients. Treatment involved surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measures like gastrointestinal decompression, fluid resuscitation, hemodynamic support. Four patients who expired due to sepsis & MODS had comorbidities, rest were discharged.

Discussion: MI is not uncommon in covid19 patients. Second wave in India was due to Delta variant which was a severe form. Perhaps severity of disease goes hand in hand with severe inflammatory response, cytokine storm and hypercogulable state. Most patients present late, hence may need bowel resection. Inspite of being on anticoagulants or antiplatelets,
they can develop mesenteric ischemia. Long term anticoagulation is required. More than 1
arterial system may be involved.


Disclosures:


Sanjay Kumar, FACG, Sunil Kasturi, MD, DM, Sandesh Sharma, MS, Naveen Tmu, MD, DM, Neetu kumar, MD, Vinod Narkhede, MD, Kshitij Kumar, MBBS. P1259 - Acute Mesenteric Ischemia in COVID-19 Patients: A Case Series, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.