Gastrointestinal perforation in COVID-19 patients – case series and review of the literature

Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2) involving the respiratory tract started in 2019 in Wuhan, China but spread to almost all parts of the world to the extent that it was declared a pandemic by WHO. As more and more cases are detected, the involvement of systems other than respiratory was observed and nearly 5 to 50 % of patients have abdominal symptoms like pain and diarrhea. During the course of treatment, few patients developed a rare complication of gastrointestinal perforation. Three cases (two with colonic perforation and one with gastric perforation) of gastrointestinal perforation in COVID-19 positive patient are reported in the article with a review of the literature regarding the various hypothesis of intestinal perforation in these patients. Keywords: COVID-19; gastrointestinal perforation; severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2); Tocilizumab

COVID-19 and Intestinal Ischemia: A Multicenter Case Series

“…Increased CRP is also reported in the previous studies ( 5 , 11 , 26 ) and is known as a marker of poor prognosis among COVID-19 patients ( 27 , 28 ). Similar to the previous studies ( 7 , 8 ), D-dimer was also significantly increased among our patients, surpassing 5,000 ng/mL in some patients. D-dimer is a predictive factor of disease severity and mortality among COVID-19 patients ( 8 , 13 , 27 , 28 ) and is also suggestive of thrombotic microangiopathy ( 13 , 14 ).…”

“…The symptoms and signs of intestinal ischemia were initiated 7 days following the respiratory manifestations of COVID-19. The precedence of respiratory manifestations has also been mentioned in the previous studies ( 6 , 7 , 10 , 11 , 26 ). However, some studies report the concomitant PCR confirmation of COVID-19 and intestinal ischemia ( 7 , 8 , 12 ).…”

“…The precedence of respiratory manifestations has also been mentioned in the previous studies ( 6 , 7 , 10 , 11 , 26 ). However, some studies report the concomitant PCR confirmation of COVID-19 and intestinal ischemia ( 7 , 8 , 12 ). Although most patients presented with gastrointestinal manifestations, two patients were not suspected of intestinal ischemia until imaging studies were ordered.…”

COVID 19 and the risk of gastro-intestinal perforation: A case series and literature review

“…We found 18 perforations in patients not treated with IL-6 inhibitors. Of these 18 cases, 12 were lower GI perforations ( [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] ), 6 were perforated gastroduodenal ulcers ( 8 , [11] , [12] , [13] , [14] ). One of these after embolization of a bleeding ulcer ( 15 ).…”

Spontaneous intestinal perforation in critical COVID: A case report

“…Fortunately, recent studies [14] have found that in some stable patients with a confined and limited perforation, nonoperative therapy may be utilized successfully. Nonoperative approaches can be considered if GI perforation is confined and possibly treated successfully by combination of antibiotics intervention, and if surgical intervention is required, the appropriate method can be chosen on an individual basis.…”