A Rare Case of Colon Perforation in a COVID-19 Young Patient

Internal Medicine Unit, Ospedale del Mare, ASL Napoli 1 Centro , Naples, Italy
Gastroenterology Unit, Ospedale del Mare , ASL Napoli 1 Centro, Naples, Italy
Covid Medicine Unit ,Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy

Posters & Accepted Abstracts: Health Sci J

Abstract:

Background: Although respiratory symptoms predominate in COVID-19, abdominal complications can occur in COVID-19 patients. Case history: We report an 26-year-old patient who presented to the emergency room with severe abdominal distention. He had a 2 week history of persistent fever and cough in SARS-Cov2 infection. Laboratory: WBC 19,600 cells/mm3,CRP 20,57 mg/L,DDimer 5830.0 microg/L and procalcitonin 9,18 ng/ml. Abdominal CT showed pneumoperitoneum and ascending colon wall thickening. The patient underwent emergent laparotomy and he was found a multiple transverse colon perforation. He underwent segmental resection of the transverse colon and ileostomy. He was diagnosed with a severe COVID-19 pneumonia and required noninvasive ventilation. In the hospital the patient suffered severe intestinal bleeding treated with interventional radiographic embolization. The Pathology revealed extensive areas of ischemic changes, including extensive necrosis, microvascular thrombosis and focal hemorrages. The patient was discharged after 35 days. Discussion: Pathogenesis behind acute intestinal ischemia caused by SARS-COV2 is multifactorial including diffuse endothelial inflammation, increased procoagulant factors and direct bowel damage by SARS-COV2 given high affinity to ACE2 receptor including ileal and colinic enterocytes. This is a rare case of a acute intestinal ischemia in young patient in absence of preexisting comorbidities (hypertension, diabetes, obesity, essential thrombocytosis) than can occur as complication of COVID-19. References 1. Piero Boraschi, Luigi Giugliano, Giuseppe Mercogliano, Francescamaria Donati, Stefania Romano, Emanuele Neri Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful? World J Gastroenterol 27: 4143-4159. 2. Bianco F, Ranieri AJ, Paterniti G, Pata F, Gallo G (2020) Acute

PDF HTML