Colonic Perforation in Critically Ill COVID-19 Patients: A Case Series Highlighting Surgical Management and Outcomes

The COVID-19 pandemic has primarily been characterized by respiratory symptoms, but emerging evidence suggests multi-organ involvement, including the gastrointestinal tract. This case report aims to highlight colon perforation as a rare but significant complication in COVID-19 patients. We present two cases of male patients, aged 38 and 33, who were admitted with severe COVID-19 symptoms and required intubation and ventilator support. Both patients developed abdominal distension during their ICU stay, prompting surgical consultations. In the first case, a 38-year-old male developed septic shock and abdominal distension on day 29 of his hospital stay. An exploratory laparotomy revealed a 2 mm perforation in the sigmoid colon, which was managed with Hartmann's procedure. In the second case, a 33-year-old male developed abdominal distension one week post-admission. An exploratory laparotomy revealed a 2 mm perforation in the mid-transverse colon, managed initially with a primary two-layer repair and later with a transverse loop colostomy due to additional perforations. These cases emphasize the importance of maintaining a high index of suspicion for gastrointestinal complications, such as colon perforation, in COVID-19 patients. Early diagnosis and surgical intervention are crucial for managing this life-threatening complication. Further research is needed to understand the incidence and underlying mechanisms of colon perforation in COVID-19 patients.