A Case of COVID-19 Pneumonia with Occlusion of the Superior Mesenteric Artery

Abstract

A 65-year-old man was admitted with a diagnosis of COVID-19. He generally looked well but complained of lower abdominal pain on the 9th day of hospitalization. The abdominal pain persisted, and two days later, signs of peritoneal irritation became apparent. Therefore, he was referred to surgical department. Plain computed tomography (CT) revealed an extensive intramural emphysema in the small intestine, and emergency surgery was indicated for intestinal necrosis. Laparotomy revealed the presence of necrotic tissues in most of the small intestine and poor blood flow to the mesentery in the same region, leading to a diagnosis of superior mesenteric artery occlusion. Extensive small bowel resection was performed, preserving 25 cm from Treitz’s ligament and 15 cm from the terminal ileum, and a jejunal stoma was constructed. The postoperative course was generally favorable, and postoperative abdominal contrast-enhanced CT showed an occlusion of the superior mesenteric artery at the root. The pathology of hypercoagulability due to COVID-19 remains unclear, but COVID-19 is known to increase the risk of thrombosis. Therefore, we suspected a strong relation between the occlusion of the superior mesenteric artery and COVID-19 based on the time of onset.