Mesenteric Thrombosis as a Complication of COVID-19 Infection: A Systematic Review with Meta-Analysis

Abstract Background: Coronaviruses derive their name from the Latin word “corona” meaning crown. The name refers to the unique appearance of the virus under an electron microscope as round particles with a rim of projections resembling the solar corona. They are enveloped, positive-sense, single-stranded RNA viruses which were first isolated from humans in 1965. Although this disease affects mainly the respiratory system, other organs may be involved, usually due to coagulation disturbances that lead to a high rate of thrombotic complications. In this regard, deep vein thrombosis has been reported in up to 25-50% of COVID-19 patients requiring intensive care, with mortality rates being as high as 30-40%. Although less frequent, other thrombotic events such as intestinal, cerebral, and peripheral limb thrombosis have been reported, usually in critical patients. Concerning intestinal damage, the prothrombotic effects of the virus rise the incidence of mesenteric ischemia from a mere 0.09-0.2% in the general population to 1.9-3.8% in patients with COVID-19. Furthermore, complement activation through the alternative and lectin pathways results in endothe-lial injury and arteriolar thrombosis. Hence, it is believed that micro vascular changes, rather than major embolic events, play a central role in intestinal damage. It is important to note that venous thromboembolic complications are generally more common than arterial thrombosis. In Mesenteric ischemia, the time lag between onset of symptom to treatment is crucial for good outcome. The optimal time for intervention is initial 12 hours from symptom onset, when it is possible to perform vascular surgery effectively without requiring intestinal resection. However, patients with COVID-19 often present late and treatment of respiratory symptoms is given precedence over abdominal symptoms. Mucosal ischemia may further induce massive spread of virus from bowel epithelium leading to vasoplegic shock after surgery.
Aim of Work: To investigate the prevalence and outcomes of COVID-19 patients with digestive thrombo-embolic events. And outline the preventive measures which can avoid this complication.