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COVID-19 Associated Spontaneous Bowel Perforation

Received: 7 March 2021     Accepted: 19 March 2021     Published: 30 March 2021
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Abstract

The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients’ demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.

Published in Journal of Surgery (Volume 9, Issue 2)
DOI 10.11648/j.js.20210902.16
Page(s) 74-77
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Colonic Perforation, COVID-19, Hemicolectomy

References
[1] Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020. https://doi.org/10.1016/S2468-1253(20)30083-2.
[2] Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastroin- testinal infection of SARS-CoV-2. Gastroenterology. 2020. Published online Mar 3. https://doi.org/10.1053/j.gastro.2020.02.055.
[3] Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020; 51: 843–851. https://doi.org/10.1111/apt.15731].
[4] Paola De Nardi, Danilo C Parolini, Marco Ripa, Sara Racca, Riccardo Rosati. Bowel perforation in a Covid-19 patient: case report. Int J Colorectal Dis. 2020 Sep; 35 (9): 1797-1800.
[5] Hang W, Du RH, Li B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020; 9 (1): 386-389.
[6] [Cheung KS, Hung IF, Chan PP, Lung K, Tso E, Liu R, Ng Y, Chu MY, Chung TW, Tam AR, Yip CC, Leung K-H, Yim-Fong Fung A, Zhang RR, Lin Y, Cheng HM, Zhang AJ, To KK, Chan K-H, Yuen K-Y, Leung WK, Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort and Systematic Review and Meta-analysis, Gastroenterology (2020), doi: https://doi.org/10.1053/j.gastro.2020.03.065].
[7] ZhuN, Zhang D et al (2020) A novel corona virus from patients with pneumonia in China, 2019. N Engl J Med 382: 727–733. https://doi. org/10.1056/NEJMoa2001017
[8] Yuan Tian, Long Rong, Weidong Nian, Yan He (2020) Review article: gastrointestinal features in COVID-19 and the possibility of faucal transmission Aliment Pharmacol Ther 51: 843-851. Published online 2020 Mar 31. doi: https://doi.org/10.1111/apt.15731, 843, 851.
[9] Martin AI, Rao G. Martin AI, et al. Methodist Debakey Cardiovasc J. COVID-19: A Potential Risk Factor for Acute Pulmonary Embolism. 2020 Apr-Jun; 16 (2): 155-157. doi: 10.14797/mdcj-16-2-155.
[10] Kangas-Dick A, Prien C, Rojas K, Pu Q, Hamshow M, Wan E, Chawla K, Wiesel O. Kangas-Dick A, et al. SAGE Open Med Case Rep. 2020 Jul 16; 8: 2050313X20940570. doi: 10.1177/2050313X20940570. E Collection 2020.
[11] Handaya AY, Andrew J, Hanif AS, Fauzi AR. Handaya AY, et al. Covid-19 mimicking symptoms in emergency gastrointestinal surgery cases during pandemic: A case series. Int J Surg Case Rep. 2020 Oct 24; 77: 22-27. doi: 10.1016/j.ijscr.2020.10.064. e Collection 2020.
[12] Rojo M, Cano-Valderrama O, Picazo S, Saez C, Gómez L, Sánchez C, Sanz-Ortega G, Torres AJ. Intestinal perforation in patient with COVID-19 infection treated with tocilizumab and corticosteroids. Report of a clinical case. 2021 Feb; 99 (2): 156-157. doi: 10.1016/j.ciresp.2020.04.030. Epub 2020 Apr 29.
[13] Giuffrè M, Bozzato AM, Di Bella S, Occhipinti AA, Martingano P, Cavallaro MFM, Luzzati R, Monica F, Cova MA, Crocè LS. Giuffrè M, et al. Spontaneous Rectal Perforation in a Patient with SARS-CoV-2 Infection. J Pers Med. 2020 Oct 8; 10 (4): 157. doi: 10.3390/jpm10040157.
[14] Kotfis K, Skonieczna-Żydecka K. COVID-19: gastrointestinal symptoms and potentialCOVID-19: gastrointestinal symptoms and potential sources of 2019-nCoV transmission. Anaesthesiol Intensive. 2020; 52: 1. doi: 10.5114/ait.2020.93867.
[15] Jin X, Lian J-S, Hu J-H. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020; 0: 1–8. doi: 10.1136/gutjnl-2020-320926.
[16] Gu Jinyang, Han Bing, Wang Jian. COVID-19: Gastrointestinal Manifestations and Potential Fecal–Oral Transmission. Gastroenterology. 2020; 158 (6): 1518–1519. doi: 10.1053/j.gastro.2020.02.054.
Cite This Article
  • APA Style

    Mohammed Alkatary, Hamda Al Zarooni, Salem Al Harthi. (2021). COVID-19 Associated Spontaneous Bowel Perforation. Journal of Surgery, 9(2), 74-77. https://doi.org/10.11648/j.js.20210902.16

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    ACS Style

    Mohammed Alkatary; Hamda Al Zarooni; Salem Al Harthi. COVID-19 Associated Spontaneous Bowel Perforation. J. Surg. 2021, 9(2), 74-77. doi: 10.11648/j.js.20210902.16

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    AMA Style

    Mohammed Alkatary, Hamda Al Zarooni, Salem Al Harthi. COVID-19 Associated Spontaneous Bowel Perforation. J Surg. 2021;9(2):74-77. doi: 10.11648/j.js.20210902.16

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  • @article{10.11648/j.js.20210902.16,
      author = {Mohammed Alkatary and Hamda Al Zarooni and Salem Al Harthi},
      title = {COVID-19 Associated Spontaneous Bowel Perforation},
      journal = {Journal of Surgery},
      volume = {9},
      number = {2},
      pages = {74-77},
      doi = {10.11648/j.js.20210902.16},
      url = {https://doi.org/10.11648/j.js.20210902.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210902.16},
      abstract = {The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients’ demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - COVID-19 Associated Spontaneous Bowel Perforation
    AU  - Mohammed Alkatary
    AU  - Hamda Al Zarooni
    AU  - Salem Al Harthi
    Y1  - 2021/03/30
    PY  - 2021
    N1  - https://doi.org/10.11648/j.js.20210902.16
    DO  - 10.11648/j.js.20210902.16
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 74
    EP  - 77
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20210902.16
    AB  - The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients’ demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.
    VL  - 9
    IS  - 2
    ER  - 

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Author Information
  • General Surgery Department, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE

  • General Surgery Department, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE

  • General Surgery Department, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE

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