Ischemic Bowel as a Thrombotic Complication of COVID-19: A Case Report

Background: Coronavirus disease 2019 (COVID-19) is now recognized as a multisystem illness associated with a significant risk of thrombotic complications due to a hypercoagulable state. While venous thromboembolism is well documented, gastrointestinal ischemia remains a rare but severe manifestation. The incidence, clinical course, and outcomes of COVID-19-associated ischemic bowel are not well characterized, though available reports suggest high mortality. Proposed mechanisms include endothelial injury, inflammatory-mediated coagulation activation, and elevated prothrombotic factors. Case: A 67-year-old male presented to the emergency department with several days of generalized weakness and exertional dyspnea. Initial diagnostic considerations included anemia, dehydration, electrolyte abnormalities, and infection. Further evaluation revealed acute COVID-19 infection complicated by thrombotic disease resulting in ischemic bowel. His hospital course was prolonged and complex, marked by multiple complications and progressive functional decline. Despite aggressive medical management and supportive care, his prognosis remained poor. He was ultimately discharged to a long-term acute care facility with a tracheostomy tube, enteral feeding dependence, and continued mechanical ventilation. Conclusion: This case underscores the prothrombotic potential of COVID-19-associated hypercoagulability and highlights ischemic bowel as a rare yet devastating complication. Clinicians should maintain a high index of suspicion for thrombotic events in patients with COVID-19, even when initial symptoms are nonspecific, as delayed recognition may result in significant morbidity and mortality.