A surge in Mesenteric Ischemia cases in a short span is being observed by surgical gastroenterologists at the Nizam’s Institute of Medical Sciences (NIMS), Panjagutta. Usually, six to seven cases are detected at the institute in a year among people with protein deficiency, the elderly with atherosclerosis, or those with co-morbidities.
The NIMS doctors have come across six cases in 3-4 days in the last week alone. It was observed especially in the younger population with no co-morbidities. Detection in late stages can be life-threatening.
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All the six patients required removal of a significant segment of intestine. Four of the patients needed ventilator support, of which two ultimately succumbed to the disease. The remaining four patients are in a good condition.
Head of the surgical gastroenterology department at NIMS, N. Bheerappa pointed the needle of suspicion at COVID-19 as the reason for the recent surge in Mesenteric Ischemia cases.
“None of the patients reported to have had any history of COVID illness or exposure. Only two of them had received a single dose of vaccine. Still, antibodies against coronavirus were significantly positive in all six of them pointing to a role of COVID in increase in thrombotic tendencies,” Dr Bheerappa said. COVID-19 has been shown to cause an increase in the clot-forming tendency in blood.
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He said that this situation calls for a debate on whether anti-coagulants should be continued 10-14 days after COVID is detected.
Early detection is key
The main risk factors for thrombotic (clots in blood vessels) complications are male gender, hypertension, obesity, cardiovascular disease, and prolonged immobilisation.
“Mesenteric Ischemia should be suspected in patients having symptoms like nausea, vomiting, severe abdominal pain, passing blood or black coloured stools or abdominal distension. Blood tests may show an altered ABG (arterial blood gas), prothrombin time, ferritin, lactate, and Ddimer. Triphasic CECT abdomen with mesenteric angiography is the diagnostic imaging of choice to confirm the condition Mesenteric Ischemia,” he said.
Treatment of AMI ranges from infusion of blood thinners to surgical removal of large segments of affected intestine. Prognosis can be bad if a significant amount of intestines is removed. Patients sometimes require long-term nutritional support, hospital or ICU stay.
To minimise the damage, it is crucial that people know the symptoms of the condition and consult doctors whenever they spot the symptoms.
“Early recognition and prompt management is key to successfully achieving good outcome,” he said, adding that damage to the intestines can be reduced if detected in early stages.