Colon perforation as a complication of COVID-19: a case report

Abstract

Background Coagulopathy induced by COVID-19 has received much attention. Arterial and venous thrombosis of multiple organs due to COVID-19-related coagulopathy is associated with a poor outcome. Case presentation A 67-year-female was transferred to our hospital in need of intensive care for severe COVID-19 pneumonia. On day 7 after admission, despite the treatments, her respiratory and hemodynamic status deteriorated. Computed tomography revealed massive ascites and free air as well as wall defects of the transverse colon. An emergency laparotomy was undertaken in the intensive-care unit, and 17 cm of the transverse colon was resected. Histopathological findings revealed two perforation sites of 25 and 7 mm in diameter, necrosis of the intestinal mucosa around the perforation sites, and the microcirculatory thrombosis in the mesentery vessels which was suspected of having been induced by COVID-19-related coagulopathy. Conclusions The case highlights the risk of intestinal ischemia and perforation induced by COVID-19 coagulopathy. Physicians treating COVID-19 should recognize the risk and evaluate patients carefully.

Acute Mesenteric Ischemia in COVID-19 Patients

“…We also identified 30 case reports or case series [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] presenting 34 cases of acute bowel ischemia in patients positive for SARS-CoV-2 infection in different clinical settings. 8 cases were previously hospitalized for COVID-19 pneumonia and under anticoagulant medication ( Table 2 ).…”

“…Laparotomy with resection of the necrotic bowel should be performed as quickly as possible to avoid perforation and septic shock. In cases in which intestinal viability cannot be established with certainty, a second look laparotomy was performed after 24–48 h [ 43 ] or the abdominal cavity was left open, using negative pressure systems such as ABTHERA [ 51 ], and successive segmentary enterectomy was performed.…”

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

“…31 Gross findings include dilation of the colon with some thickening of the wall, hemorrhagic-dusky necrotic appearance of the serosal surface, petechiae, fibrinous exudates, occasional perforations, and air bubbles. 31,36,[45][46][47] Mucosal alterations included edema, patchy petechiae and erythema, occasional bleeding, focal loss of mucosal folds, erosions and areas of ulceration, areas of necrosis with dark-brown discoloration, and fibrinous exudates. 14,31,32,48,49 In about 18.5% of studied cases of ischemic colitis, a colonoscopic examination was essentially normal.…”

“…3). 14,27,29,31,32,36,[45][46][47][48][50][51][52] SARS-CoV-2 has been detected in some cases of ischemic colitis as a cytoplasmic dot-like staining pattern in the surface and crypt epithelial cells as well as in the LP cells of both inflamed and noninflamed colonic mucosa. 14,36,46,47,50 Features suggestive of vascular injury of the colon due to SARS-CoV-2 have been described, including prominent multifocal small and medium-sized vasculitis of the submucosal vessels with bizarre-appearing endothelial cells, luminal obliteration, early thrombi formation, and bleeding into vessel walls.…”

“…As in the small intestine, the most common COVID-19-associated injury of the large bowel is ischemic colitis, showing a predilection for the right colon 31 . Gross findings include dilation of the colon with some thickening of the wall, hemorrhagic-dusky necrotic appearance of the serosal surface, petechiae, fibrinous exudates, occasional perforations, and air bubbles 31,36,45–47 . Mucosal alterations included edema, patchy petechiae and erythema, occasional bleeding, focal loss of mucosal folds, erosions and areas of ulceration, areas of necrosis with dark-brown discoloration, and fibrinous exudates 14,31,32,48,49 .…”