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Pneumomediastinum and pneumoretroperitoneum after COVID-19: concealed intestinal perforation

Jiaying Shen1, Xiaoyong Shen1, Feimin Zhao1

  • 1Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang, China.

BMC Infectious Diseases
|August 8, 2024
PubMed

Insights

This case report details a rare COVID-19 complication: spontaneous gastrointestinal perforation. Early recognition and multidisciplinary intervention are crucial for managing this fatal extrapulmonary manifestation.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Radiology

Background:

  • Coronavirus disease 2019 (COVID-19) has led to severe cases globally.
  • This report highlights a rare case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation.
  • This represents the first reported instance of COVID-19-induced gastrointestinal complications.

Observation:

  • A 74-year-old female with COVID-19 developed unexpected air leakage on imaging.
  • Despite conservative initial treatment due to subtle symptoms, sigmoid colon perforation was surgically confirmed.
  • Anatomical abnormalities contributed to atypical peritonitis presentation and delayed diagnosis.

Findings:

  • The patient experienced sigmoid colon perforation, a rare extrapulmonary manifestation of COVID-19.
  • Concurrent pneumomediastinum and pneumoretroperitoneum were noted.
  • Atypical peritonitis symptoms were observed due to abnormal air leakage direction.

Implications:

  • Clinicians must maintain vigilance for spontaneous gastrointestinal perforation in COVID-19 patients, especially those on glucocorticoids and tocilizumab.
  • Early diagnosis and multidisciplinary intervention, including imaging, are vital for reducing mortality.
  • This case underscores the importance of recognizing rare extrapulmonary complications of COVID-19.
Abstract

Keywords:
Air leakageCOVID-19Intestinal perforationPneumomediastinumPneumoretroperitoneum

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