Acute Aortic Thrombosis Complicated with Acute Abdomen in COVID-19 Patient

Abstract

There are thousands reports of acute aortic thrombosis as complication of COVID-19 with reported mortality of 34%-62%. One of the acute arterial events in these patients is oclusive messenteric ischemia. This condition is rare and only single cases are reported. We present a case of a 72-year-old female patient presented as acute abdomen. She was COVID-19 positive and was treated at home in the past 10 days by her family doctor. Prior to admission she had pO2 of 80% with oxygen mask. A contrast enhanced computed tomography scan of the thorax and abdomen revealed bilateral pneumonia, aortic arch thrombosis and free thrombus in the abdominal aorta. After admission saturation dropped to 20% pO2, she was reanimated and intubated. The family refused the offered exploratory laparatomy. Repeated computed tomography three days after the admission showed presence of free intraperitoneal fluid and hyperdensity of the right colon and partially of the small intestine described as intramural bleeding. The general condition of the patient gradually worsened in the next three days, and she died. Acute abdomen is a serious condition and when left untreated can result with death. One of the causes of acute abdomen is acute mesenteric ischemia. In our case the mesenteric occlusion was not proven. However, the clinical presentation of acute abdomen, the presence of free thrombus and the positive signs of intramural bleeding and free intraperitoneal fluid suggested the presence of acute mesenteric ischemia.