Perforated acute abdomen in a patient with COVID-19: an atypical manifestation of the disease

Abstract

Introduction The Coronavirus belongs to a family of RNA viruses that can cause respiratory infection, with the possibility of gastrointestinal manifestations in approximately 5—50% of the cases. Objective To report a surgical case with a diagnosis of COVID-19 that developed acute perforated abdomen and pneumothorax. Case report This was an 80-year-old female patient with respiratory symptoms, with dry cough and fever and diffuse abdominal pain with signs of peritonitis. She had leukocytosis, kidney dysfunction and an increase in D-dimer with positive PCR for COVID. Computed tomography of the chest and abdomen showed pneumothorax on the right and extensive pneumoperitoneum. Conclusion The presentation of COVID-19 with severe pulmonary and abdominal complications requires specialized and emergency treatments, but it has high mortality rates.

Case report: Spontaneous pneumothorax in resolved, uncomplicated COVID-19 Pneumonia-A literature review

“…However, the associated severity and prognosis of spontaneous pneumothorax concomitantly in COVID-19 infection has yet to be established [ 9 ]. Interestingly, in our case study and others, pneumothorax occurred days to weeks after onset of symptoms [ 1 , 2 , 3 , 4 , 5 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Even though our patient did not present with evidence of cysts or bullae on initial CXR or CT, the delayed time frame to onset of pneumothorax could have given rise to pulmonary changes which predisposed him to pneumothorax.…”

“… Zhou, et al [ 32 ], April 2020, Hangzhou, Zhejiang, China 1 38 Male Not reported Pneumomediastinum, subcutaneous emphysema Conservative Recovered and discharged 30. Correa Neto et al [ 33 ], May 2020, Sao Paulo, Brazil 1 80 Female Hypertension, CAD Pneumothorax, pneumoperitoneum Intubation, chest tube, exploratory laparotomy Expired 31. Kolani et al [ 34 ], May 2020, Fez, Morocco 1 23 Female Nil Pneumomediastinum Conservative Recovered and discharged 32.…”

Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review

“…There has been one case report of abdominal CT demonstrating extensive pneumoperitoneum with free intracavitary fluid [ 43 ]. Subsequent laparotomy revealed the cause to be perforation of the sigmoid colon accompanied by reduced perfusion of the entire GI tract.…”

Development of a large spontaneous pneumothorax after recovery from mild COVID-19 infection

“… 18 A more unusual case was an 80-year-old woman who had both a right pneumothorax and extensive pneumoperitoneum at the time of presentation for COVID-19. 19 In a case report from Turkey, a 24-year-old non-smoking man presented with COVID-19 pneumonia and a large left pneumothorax. 20 A 61-year-old man in Germany, again a non-smoker, presented 17 days after hospitalisation for COVID-19 pneumonia with a right-sided tension pneumothorax, and then 20 days later, he developed a left-sided tension pneumothorax after a coughing fit, without evidence of any new infection, supporting the theory that increased intrathoracic pressure caused by frequent and heavy coughing could be one of the explanations for the development of barotrauma complications in these patients.…”