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Small Intestine Perforation in a 69-Year-Old Man with COVID-19
Arash Miroliaee1, Najmeh Aletaha2, Nasser Ebrahimi Daryani3
1Assistant Professor, Department of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
This case report highlights a rare complication of Coronavirus disease 2019 (COVID-19): bowel perforation. This serious gastrointestinal issue can occur due to ischemia or vasculitis, even after initial recovery from respiratory symptoms.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is a global pandemic with significant mortality and morbidity.
- While lung involvement is primary, multi-organ complications, including neurological, cardiac, and thromboembolic events, contribute to adverse outcomes.
- Increasing data reveals a wide spectrum of organ involvement and complications associated with COVID-19.
Observation:
- A 69-year-old male patient presented with severe abdominal pain and fever, readmitted 10 days after initial COVID-19 treatment.
- Initial COVID-19 diagnosis was confirmed by lung CT and positive PCR; treatment included remdesivir and prophylactic heparin.
- During the second admission, abdominal imaging revealed bowel perforation, confirmed during laparotomy as suppurative peritonitis and proximal jejunal perforation.
Findings:
- The patient underwent bowel resection and primary anastomosis for jejunal perforation.
- No definitive etiology for the perforation was identified during surgery, suggesting a potential link to COVID-19 complications.
- The patient was discharged in good condition after 5 days post-surgery.
Implications:
- This case underscores that bowel perforation, potentially due to ischemia or vasculitis, is a critical complication of COVID-19.
- Gastrointestinal symptoms in COVID-19 patients warrant a high index of suspicion for such surgical emergencies.
- Clinicians should consider COVID-19-related mesenteric ischemia or vasculitis in the differential diagnosis of acute abdominal conditions.
Abstract:
Coronavirus disease 2019 (COVID-19) had caused pandemia with a high rate of mortality and morbidity. Lung involvement is the main cause of mortality, but central nervous system and cardiac disease, and thromboemboli may participate in increasing mortality. A wide spectrum of organs involvement and complication has been reported as data gathering during the pandemia has progressed. We report a 69-year-old man who was admitted to Imam Khomeini hospital in Tehran and complained of severe abdominal pain and fever. He had been admitted 10 days earlier because of dyspnea and fever. At the first admission, based on the findings in the lung computed tomography (CT) and a positive nasopharyngeal polymerase chain reaction (PCR) test for COVID-19, he was treated with intravenous remdesivir for 5 days and prophylactic anti-coagulant heparin during hospital admission. Two days before the new admission, he was discharged with relative recovery. During the new admission, because of the absence of hypoxemia and leukocytosis diagnostic approach to abdominal pain was planned. In abdominal imaging, evidence of bowel perforation appeared. In laparotomy, suppurative peritonitis and proximal jejunal perforation without definite etiology were seen, and bowel resection and primary anastomosis were done. After 5 days, the patient was discharged in good condition. This case is reported to inform that bowel perforation due to ischemia or vasculitis may complicate the course of COVID-19 and, in cases of gastrointestinal symptoms, should be considered.
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