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Eduardo Linhares

Department of Gastro Intestinal Surgery Hospital das Americas, Brazil

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Acute Abdomen in COVID-19: A Rare Image

* Eduardo Linhares; Claudio Domenico; Amarino Junior;
  • * Eduardo Linhares: Department of Gastro Intestinal Surgery, Hospital das Americas, Brazil.
  • Claudio Domenico: Department of Cardiology, Hospital das Americas, Brazil.
  • Amarino Junior: Department of Radiology, Hospital das Americas, Brazil
  • 16 Aug 2020 |
  • Volume: 1 |
  • Issue: 4 |
  • Views: 151 |
  • Downloads: 182
  • Download PDF

Clinical Image

COVID-19 was first described in Wuhan-China and soon after delaring a pandemic according to WHO. In Brazil, it truly became a health problem, with more than 2 million cases. Clinically, the disease manifests as pneumonia, but abdominal surgeons have been called since the beginning to face acute abdominal syndromes associated with this disease. The most were related to mesenteric lymphadenitis and managed without surgery. But as the disease worsened a more critical presentation presented are related to inflammation, hypoxemia, and hypercoagulability [1].

We report a case of a 74-year-old male with severe COVID in the ICU who presented sudden abdominal distension. The CT scan disclosed the images below suggesting intestinal ischaemia (Figure 1 and 2).


He was operated on the same day and in the operation, we found acute pancreatitis with intestinal ischaemia and mesenteritis. The patient died in 48 hours. After reviewing the literature, we found a radiologist update [2,3] reporting some other related images and the mechanism of injury of the GI tract. The virus binds to the Angiotensin-Converting Enzyme 2 (ACE2) receptor in the lung inciting thrombosis. These receptors are expressed at high levels in gastrointestinal mucosa and pancreatic cells plaining the mechanism of local ischaemia.

References

  1. Spiezia L, Boscolo A, Poletto F, Cerruti L, Tiberio I, Campello E, et al.. COVID-19-Related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost. 2020;120(6):998–1000.
  2. Gartland RM, Velmahos GC. Bowel Necrosis in the Setting of COVID-19. J Gastrointest Surg. 2020;1–2.
  3. Olson  MC, Lubner MG, Menias CO, Mellnick VM, Gettle LM, Kim DH, et al. RadioGraphics Update: Venous Thrombosis and Hypercoagulability in the Abdomen and Pelvis-Findings in COVID-19. Radiographics. 2020;200119.

Cite this article

Linhares E, Domenico C, Junior A. Acute abdomen in covid-19: a rare image. Clin Surg J. 2020;1(4):1–2.

Copyright

© 2020 Eduardo Linhares. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-4.0).

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