Acute mesenteric thrombosis in two patients with COVID-19. Two cases report and literature review

INTRODUCTION

The coronavirus disease 2019 (COVID-19) affects mainly the respiratory system, other organs may be involved, usually due to coagulation disturbances that lead to a high rate of thrombotic complications.

CASE PRESENTATION

The first patient is 45 years-old who has been exposed to SARS CoV-2. Upon admission due to acute abdomen evidence surgery is performed in which an intestinal resection with an adequate post-surgical evolution takes place so the patient is discharged after 4 days with a prescription for oral anticoagulants. The second one is 42 years-old and has comorbidities. The patient is admitted upon evidence of COVID-19, after showing signs of vein mesenteric ischemia in a CT scan surgery is performed, however the patient dies 24 h after the intervention.

DISCUSSION

Within severe cases of patients with COVID-19 the incidence of a symptomatology or gastrointestinal complications is high (39-73.8%). Thromboprophylaxis is recommended to all patients admitted for COVID-19, starting with heparin of low molecular weight as prophylaxis, as well as continuing with oral anticoagulants after being discharged.

CONCLUSION

Despite the fact that knowledge of the disease is rapidly advancing, all available treatments are still nonspecific to SARS-CoV-2 and the optimal management of COVID-19 remains unclear. An unexplained clinical picture should raise the suspicion for rare conditions such as mesenteric thrombosis. Adequate prophylactic measures should be implemented both during hospitalization and after discharge.

Minimally invasive therapy for epiphrenic diverticula: Systematic review of literature and report of six cases

INTRODUCTION:

Epiphrenic diverticula (ED) are infrequent and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach but some surgical controversies are not resolved.

OBJECTIVE:

The objective of this study is to describe our experience in minimally invasive treatment of the ED and to perform a systematic review of the current literature in this subject.

MATERIALS AND METHODS:

We reviewed all data from the Hospital de Sant Pau, focusing on patients that underwent minimally invasive treatment for an ED since 1998 to date. Furthermore, we performed a systematic literature review focused on the minimally invasive approach for ED.

RESULTS:

A total of 6 patients have been treated (5 transhiatal and 1 with abdominal and thoracic approach). We found a predominance of males with a median age of 63. The diagnosis was made with an endoscopy, barium swallow and manometry. Half of the manometry results were pathologic. The surgical technique involved a diverticulectomy, myotomy and a Dor partial founduplication. Two patients that presented suture line leakage (SLL) were treated conservatively. No mortality was reported. The systematic review was carried out under the Preferred Reporting Items for Systematic Reviews and Meta-analyses scheme, with a total of 20 studies where 189 patients were found. No comparative or prospective randomised trials were found. Overall morbidity was 24%, with a SLL rate of 12%, hospital stay of 5 days and mortality of 1.5%. After a median follow-up of 42 months, 81.5% of the patients were asymptomatic.

CONCLUSION:

The minimally invasive approach for ED is a safe and feasible procedure.