An Intriguing Case of Pneumoperitoneum In a Patient With COVID-19: Do All Pneumoperitoneum Cases Need Surgery?

Pneumomediastinum and pneumoretroperitoneum after COVID-19: concealed intestinal perforation

BACKGROUND

With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications.

CASE PRESENTATION

A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease.

CONCLUSIONS

Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.

[Spontaneous idiopathic pneumoperitoneum in a patient with COVID-19]

The authors present a patient with COVID-19 and spontaneous idiopathic pneumoperitoneum. A 77-year-old man suffering from coronary artery disease, diabetes mellitus and cognitive disorders was diagnosed with bilateral pneumonia and COVID-19. Oxygen support through a face mask was prescribed. After 21 days, oxygen saturation decrease and mild abdominal symptoms required CT-based examination. Pneumoperitoneum without pneumothorax and pneumomediastinum was revealed. Explorative laparotomy found no abdominal diseases. According to the literature, spontaneous pneumoperitoneum in patients with COVID-19 is usually associated with high pressure oxygen therapy, but not always associated with intrathoracic complications. Conservative treatment may be appropriate in patients with spontaneous pneumoperitoneum, but any unclear findings can require surgery.

Massive emphysema subcutis, pneumothorax, pneumomediastinum and pneumoperitoneum as uncommon complication of covid-19 pneumonia, a rare case

We should be aware of the uncommon presentation during the pandemic scenario of the Coronavrus disease 2019 (COVID-19). Pneumothorax, pneumomediastinum, pneumoperitoneum, and massive emphysema subcutis are uncommon complications of COVID-19 Pneumonia. The presence of pneumomediastinum and massive emphysema subcutis were rarely reported in the literature. We present a 69-year-old man with COVID-19 Pneumonia with these complications who were managed conservatively and experienced spontaneous resolution of the complications two weeks later. He was admitted to the intensive care unit and was given a ventilator. Pneumonia, massive emphysema subcutis, pneumomediastinum, and pneumothorax are identified from chest X-ray. An Unenhanced thoraco-abdominal computed tomography Scan revealed the presence of a small pneumoperitoneum. However, a computed tomography scan of the abdomen and pelvis did not show any evidence of bowel perforation. It is necessary to detect these complications earlier, so the management can reduce the associated morbidity and mortality.