Superior Mesenteric Vein, Splenic Vein And Portal Vein Thrombosis With Bowel Gangrene In Covid-19 And HIV Positive Patients: A case report
Author(s): Juee Meghe*, Meenakshi Yeola, Abhyuday Meghe and Yeshwant Lamture
COVID-19 pandemic which broke out in Wuhan province of China in December of 2019 has rapidly spread globally with millions of deaths in the past one and half year. Along with severe lower respiratory tract infection it also causes coagulopathy due to an imbalance in the coagulation homeostasis. Here we report a case of superior mesenteric artery thrombosis with bowel gangrene in a COVID-19 and HIV positive female patient with its management. A female patient presented with complaint of pain in abdomen since 15 days. On per abdominal examination the abdomen was tender with guarding, rigidity and distention. X-ray abdomen ERECT was done which was significant of free gas under right dome of diaphragm. CECT abdomen pelvis was significant of thrombus in the superior mesenteric vein, portal vein, splenic vein with the evidence of perforation. Urgent laparotomy was done, after surgery patient developed multiple opacities in bilateral lung and repeat RT-PCR was done which turned out to be positive for COVID-19. Unfortunately patient died on 4 postoperative days due to ARDS related to COVID-19 pneumonia. Elderly male patients with comorbidities such as hypertension and diabetes mellitus are more likely to develop severe COVID-19 complications and are more susceptible to thromboembolism. Drugs such as low molecular weight heparin should be administered as soon as a patient is hospitalized for COVID-19 infection to prevent vascular thrombosis and end organ failure. Immunosuppressed patients with conditions like cancer, HIV, TB, etc. should be monitored under intensive care following the government protocols. Once the patients are recovered from COVID-19, they have to take care of their high blood pressure and blood sugar level should be monitored and kept under control. It is advisable that the patients should get their cardiac investigations done within 21 days of their positive results. This can prevent post COVID complications like MI, stroke DVT, PE, etc.