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Up to 17.6% of COVID-19 positive patients present with gastrointestinal symptoms and bowel wall abnormalities have been described in up to 31% of COVID-19 positive patients. Here, we present a case of a 40-year-old male diagnosed with COVID-19 complicated by hemorrhagic colitis leading to colonic perforation. CT scan of abdomen and pelvis demonstrated markedly distended descending and sigmoid colon with poorly defined wall, pneumatosis, and pneumoperitoneum. The patient was taken for emergent exploratory laparotomy for extended left hemicolectomy, partial omentectomy, transverse colostomy creation, abdominal washout, repair of small bowel, and appendectomy. The patient was brought back for repeat exploratory laparotomy with ICG perfusion assessment. Patient was found to be heterozygous for factor V Leiden mutation and was never vaccinated for COVID-19. Our case demonstrates a novel use for indocyanine green (ICG) to assess perfusion and underscores the importance of completing a thorough hypercoagulable evaluation following COVID-19 induced thrombotic event.

Hepatic artery infusion pump chemotherapy (HAIPC) for colorectal liver metastasis (CRLM) is a new technique in the treatment of CRLM, whose side effects are not well studied. Case Report: This paper aims to understand the side effect profile of HAIPC as it relates to recurrent pleural effusions. This is a case report of a 48-year-old male with CRLM being treated with HAIPC, who presents with recurrent pleural effusions found to be benign/transudative after right-side video-assisted thoracoscopic surgery. Discussion: This study suggests that HAIPC causes recurrent sympathetic pleural effusions as a side effect of the perihepatic inflammation of the localized chemotherapy treatment. Furthermore, we question if sympathetic pleural effusions are a prelude to hepatic toxicity from HAIPC. Lastly, this paper aims to guide the differential diagnosis of pleural effusions in the cancer patient being treated with HAIPC.

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