Large intestinal perforation secondary to COVID-19: A case report

Abstract

Introduction COVID-19 infection is generally characterized by the presence of respiratory symptoms. However, a small percentage of these patients also have gastrointestinal symptoms and complications that are associated with high morbidity and mortality. Presentation of case A 50-year-old male patient with COVID-19 infection was being treated for COVID-19 and pneumonia in the ICU. He presented with gastrointestinal symptoms, and the computed tomography (CT) scan revealed a hollow viscus perforation. Ultimately, the patient was taken to surgery, where a spontaneous perforation was found in the right colon. The defect was sutured with separate stitches. There were no complications postoperatively. Discussion Although respiratory symptoms are the most common presentation of COVID-19, about 18% of these patients may present with gastrointestinal symptoms. However, an even smaller percentage of critically ill patients may develop serious gastrointestinal complications such as perforation of the large intestine. This unusual complication requires immediate diagnosis and surgical management. Conclusion At the time of the COVID-19 pandemic, physicians must recognize COVID-19 in patients presenting gastrointestinal symptoms. A high degree of clinical suspicion enables timely diagnosis and management, thereby preventing major complications.

An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review

“…The prevalence of gastrointestinal symptoms and complications in ICU patients with severe COVID-19 is higher compared with those with mild disease (16.6% vs. 11.7%, respectively) [44,[112][113][114] and with ICU patients without COVID-19 [115].…”

“…The prevalence of gastrointestinal symptoms and complications in ICU patients with severe COVID-19 is higher compared with those with mild disease (16.6% vs. 11.7%, respectively) [44,[112][113][114] and with ICU patients without COVID-19 [115]. Hematomas appear as variable size hyperdense masses and can cause displacement and compression of surrounding structures (Figure 5A,B).…”

“…The prevalence of gastrointestinal symptoms and complications in ICU patients with severe COVID-19 is higher compared with those with mild disease (16.6% vs. 11.7%, respectively) [44,[112][113][114] and with ICU patients without COVID-19 [115]. Iatrogenic hemorrhages at the cannulation or surgical site reached an incidence of 26-31%, but the upper aerodigestive tract (including nose and mouth), the gastrointestinal tract, the genitourinary tract, and the thoracic and abdominal cavities are other relatively common sites of bleeding.…”

“…The early phase of bowel ischemia may only show contracted gasless bowel that, when progressed, may transform into dilated intestinal loops with a paper-thin wall and air-fluid levels (Figure 6C). In the late phase, transmural infarction may lead to intestinal wall pneumatosis (Figure 6B), mesenteric venous gas, pneumoperitoneum due to perforation (Figure 6E), and free fluid in the abdominal cavity [111,112,117].…”

Sigmoid Colon Perforation, Pelvic Collection, and Hydronephrosis Caused by an Ingested Chicken Wishbone

“…Most cases of ingested foreign bodies pass through the gastrointestinal tract without complications. However, the ingestion of bones, particularly fish or chicken bones, can lead to gastrointestinal perforation, with the sigmoid colon being one of the affected areas [1][2][3][4][5][6]. The diagnosis of bowel perforation caused by foreign bodies can be challenging due to its heterogeneous clinical symptoms (such as abdominal pain and constipation) and rarity.…”