Implications of COVID-19 in Acute Mesenteric Ischemia and Bowel Necrosis: A Case Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to provoke a state of hypercoagulability that may lead to devastating consequences. This has been well established since the onset of the coronavirus pandemic in 2019; however, the specific relationship between COVID-19 and thrombus formation remains poorly understood. There has been increasing documentation of gastrointestinal (GI) complications in patients infected with the virus, including potentially lethal acute mesenteric ischemia (AMI), regardless of prior history of GI disease or risk factors for hypercoagulable states. Not only is mesenteric ischemia difficult to diagnose but it is also associated with high rates of morbidity and mortality, warranting prompt identification and treatment to improve clinical outcomes. We herein present a case of diffuse intestinal necrosis secondary to mesenteric thrombus formation in a previously healthy female five days after the resolution of her COVID-19 symptoms. The high rates of morbidity and mortality linked to AMI underpin the need for clinicians to maintain a high index of suspicion for thrombotic complications of COVID, even in healthy patients. This case emphasizes the importance of a thorough history-taking, physical examination, and laboratory workup even in patients without a current COVID-19 infection or predisposing thrombotic risk factors. Additionally, it suggests that the hypercoagulable state associated with a COVID-19 infection may persist after the primary COVID-19 symptoms have resolved.