Rare case of COVID-19 presenting as acute abdomen and sepsis

Abstract

COVID-19 may present as acute abdomen although the pathophysiology remains obscure. A 45 year-old-man had severe COVID-19 pneumonia with associated pulmonary embolism, and presented with acute abdomen. He underwent emergency laparotomy, and resection of an ischemic area of the jejunum. Postoperatively, he had septic shock, acute-respiratory-distress-syndrome, and acute kidney injury necessitating continuous-renal-replacement-therapy (CRRT). We administered antibiotics and therapeutic anticoagulation along with two sessions of hemoadsorption by CytoSorb® filter, in conjunction to the CRRT. The patient finally survived. Bowel ischemia due to thromboembolic disease should be promptly treated. Extracorporeal blood purification may be useful in managing sepsis in severe COVID-19.

The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

“…Out of the 163 clinical articles available in PubMed, 58 were identified that mentioned "catecholamines and/or vasopressors". In total, 25 papers were excluded; 12 because of non-comparability of the measurement scales [25][26][27][28][29][30][31][32][33][34][35][36]; 4 because the type and dose of vasopressors were not specified [37][38][39][40]; 1 that reported combined norepinephrine and epinephrine doses [41]; 1 that only reported on patients that had survived [42]; and 7 where there were no measurements pre-and post-adsorber use in the same patient [43][44][45][46][47][48][49]. The remaining 33 articles were summarized without considering different study designs or duration of treatment.…”

Abdominal emergency related to retro and intraperitoneal lesions caused by COVID-19

“…11,12 The risk of vascular bleeding and that of tissue ischemia are linked to viral endothelial cells infection which can cause endotheliitis, disseminated intravascular coagulation and hypercoagulability. 2,13,14 In our case, the vascular dysfunction with inflammatory repercussions on the colic mucosa, as well as the cytokine strom, are the most probable underlying pathophysiological mechanisms which presumably reflects the interaction of several factors in the genesis of peritoneal and retroperitoneal lesions observed.…”

“…1 Despite the emergence of cases of digestive involvement during the coronavirus disease 2019 (COVID- 19) pandemic and the appearance of some surgical abdomen-like presentations. 2 No case of occlusive syndrome secondary to mesenteric and retroperitoneal hemorrhage has been reported in the literature. Authors report an unusual case with a review of literature.…”

Acute splanchnic vein thrombosis in patients with COVID-19: A systematic review

“…Overall, 641 articles were screened, 21 of which were selected according to the above mentioned criteria 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 . The included articles were all case reports (except for one case series [10] ), and contained description of 21 cases.…”