Citation Information :
Mandala S, Kodati R, Tadepalli A, Reddy C, Kalyan S. An Unusual Cause of Acute Abdominal Pain in Coronavirus Disease (COVID-19): Report of Two Cases. Indian J Crit Care Med 2022; 26 (9):1045-1048.
Coronavirus disease-2019 (COVID-19) is an infectious disease caused by coronavirus/2019-nCoV. It primarily manifests as lung infection, with fever and respiratory tract symptoms. Extrapulmonary complications affecting multiple organs are commonly seen, especially in critically ill patients. The reported gastrointestinal (GI) complications include transaminitis, acute pancreatitis, mesenteric ischemia, GI bleed, and ileus. Here, we report two cases of acute abdominal pain in patients with COVID-19 in their second week of illness. One patient had mild COVID-19 disease and the other had severe disease. Both patients had diffuse abdominal tenderness and raised inflammatory markers. The diagnosis of mesenteric panniculitis (MP) was made radiologically, and demonstrated with the presence of increased density of the mesentery with fat stranding (misty mesentery). Glucocorticoid administration resulted in the complete resolution of pain. They remained pain-free at 3 months of follow-up.
Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection in the United States: A multicenter cohort Study. Gastroenterology 2020;159(2):765–767.e2. DOI: 10.1053/j.gastro.2020.04.045.
Karna ST, Singh P, Revadi G, Khurana A, Shivhare A, Saigal S, et al. Frequency and impact of preadmission digestive symptoms on outcome in severe COVID-19: A prospective observational cohort study. Indian J Crit Care Med 2021;25(11):1247–1257. DOI: 10.5005/jp-journals-10071-24020.
El Moheb M, Naar L, Christensen MA, Kapoen C, Maurer LR, Farhat M, et al. Gastrointestinal complications in critically ill patients with and without COVID-19. JAMA 2020;324(18):1899–1901. DOI: 10.1001/jama.2020.19400.
Emory TS, Monihan JM, Carr NJ, Sobin LH. Sclerosing mesenteritis, mesenteric panniculitis and mesenteric lipodystrophy: A single entity? Am J Surg Pathol 1997;21(4):392–398. DOI: 10.1097/00000478-199704000-00004.
Sharma P, Yadav S, Needham CM, Feuerstadt P. Sclerosing mesenteritis: A systematic review of 192 cases. Clin J Gastroenterol 2017;10(2):103–111. DOI: 10.1007/s12328-017-0716-5.
Alyousef IA, Alsaileek ZA, Alabdulsalam MA, Almohanna MA, Alshaqhaa NA, Alqahtani MM, et al. Mesenteric panniculitis and COVID-19: A rare association. Cureus 2022;14(1):e21314. DOI: 10.7759/cureus.21314.
Jia X, Yin C, Lu S, Chen Y, Liu Q, Bai J, et al. Two things about COVID-19 might need attention. Preprints.org; 2020:2020020315. DOI: 10.20944/preprints202002.0315.v1.
Daskalogiannaki M, Voloudaki A, Prassopoulos P, Magkanas E, Stefanaki K, Apostolaki E, et al. CT evaluation of mesenteric panniculitis: Prevalence and associated diseases. Am J Roentgenol 2000;174(2):427–431. DOI: 10.2214/ajr.174.2.1740427.
Giraudo C, Fichera G, Motta R, Guarnieri G, Plebani M, Pelloso M, et al. It's not just the lungs: COVID-19 and the misty mesentery sign. Quant Imaging Med Surg 2021;11(5):2201–2203. DOI: 10.21037/qims-20-1406.