Sayani Banerjee*, Santosh Kumar Singh and Sujoy Das Thakur
Department of Emergency Medicine, Ramkrishna Care Hospital, Raipur, Chhattisgarh, IndiaFulltext PDF
Background: We are dealing with global coronavirus SARS-COV-2 pandemic, though majority of the population remain asymptomatic during the infection or develop only mild symptomatology, most commonly reported organs to be involved are lungs, respiratory symptoms being commonest. As our knowledge is evolving, it is now believed that SARS-CoV-2 can affect any organ system including Gastrointestinal (GI) system. GI symptoms like anorexia, nausea, vomiting, and diarrhea are encountered in patients and these end up being more critical than expected in normal scenario. Case Presentation: We report a case of 85 years old female, in post COVID-19 period, presented in emergency room with acute onset of pain abdomen and altered mental status with associated history of reduced oral intake for past 6 to 7 days. She was intubated and started on ventilator support secondary to severe respiratory acidosis and deteriorating sensorium. Cardboard rigidity was found during abdominal examination with absent bowel sounds, though family confirmed she was passing stool normally until the day before her presentation. CT chest revealed subcutaneous emphysema, pneumomediastinum and tension pneumoperitoneum with both lungs having obvious post COVID-19 pneumonia sequela. We managed her with intravenous fluid resuscitation, invasive ventilation, broad spectrum antibiotics and other supportive management. Surgery team managed her bowel perforation with bedside abdominal drain insertion in view of high risk for operation secondary to her co-morbid status. In spite of all efforts she died. Discussion: We believed that our patient might had a complication of bowel perforation, most probably involving upper part of the gastrointestinal tract suggested by presence of subcutaneous emphysema in neck and pneumomediastinum, apart from tension pneumoperitoneum, as a post COVID-19 sequel. Apart from direct bowel wall inflammation by SARS-CoV-2, intestinal dysbiosis, as well as immunological alteration in lung via gut-lung axis, local disseminated intravascular coagulation, vasculitis secondary to hypercoaguable state in COVID-19 infection, bowel edema leading to over distension of bowel all, play important pathophysiology in bowel perforation, a possible fatal complication in COVID-19 patients, that physicians should be conversant of, especially in critically ill patients or with multiple comorbidity, as these patients may or may not present with gastrointestinal symptoms.
Banerjee S, Singh SK, Thakur SD. Pneumomediastinum, Tension Pneumoperitoneum Secondary to Bowel Perforation in Post COVID-19 Patient: A Case Report. Ann Clin Case Rep. 2021; 6: 1915..