A 38 year old male with no identifiable co-morbidities presented to the emergency department complaining of a 2-day history of progressively worsening abdominal pain, nausea, intractable vomiting and shortness of breath. Examination reveals tachycardia, respiratory distress, and abdominal pain out of proportion to the palpation. Apart from mild leukocytosis and a lactate of 2.2 mmol/L, D-Dimer 2100 ng/ml. All other laboratory investigations were normal. After normal plain films of the abdomen and chest, the patient underwent a computed tomography (CT) scan of the abdomen with contrast.\nThe scan revealed extensive thrombosis of the portal, splenic, superior and inferior mesenteric veins. The mid-portion of the small bowel was suggestive of venous ischemia. No pneumatosis intestinalis was noted. An incidental finding of a totally occluded right pulmonary artery consistent with a pulmonary embolism was noted.\nThe patient received heparin therapy prior to a diagnostic laparoscopy. Intra-operatively a markedly dusky jejunal segment was identified along with turbid fluid in all quadrants. Conversion to open laparotomy ensued followed by resection of the diseased segment with temporary abdominal closure (). The patient was admitted to the ICU for resuscitation and anticoagulation. The patient was later taken to theatre for a side to side anastomosis. The patient was subsequently placed on extracorporeal membrane oxygenation (ECMO) and is currently under care in the intensive care unit (ICU).
A 48 year old male with a history of asthma presented to our institution with a cough, shortness of breath and a fever. The patient subsequently tested positive for Covid-19 and was intubated and admitted to the ICU with hypoxic respiratory failure after failure to improve with initial therapy. The patient was started on therapeutic enoxaparin treatment.\nOn the 10th day the patient was on high ventilator settings and minimal inotropic support. On examination, lower limbs showed unsalvageable ischemia with no palpable pulses (). Urgent CT angiography revealed complete occlusion of the left arterial tree from the aortic bifurcation descending down to the infra-popliteal arteries. Contralaterally, distal occlusion of the superficial femoral artery down to the infra-popliteal arteries. CT of the lung displayed ground glass appearance of the lungs associated with consolidation. After consulting the next of kin and the risk; benefit of proceeding to surgery. The joint decision to provide supportive care was made. The patient was declared dead on the same day.