P1277 - A Rare Case of Bowel Perforation Secondary to COVID-19 Infection

Dina Alnabwani, MD¹, Anish Kumar Kanukuntla, MD², Priyaranjan Kata, MD¹, Pramil Cheriyath, MD, MS¹, Chitra Lahoti, MD¹, Vinay Yalamanchi, DO^1
1Hackensack Meridian Ocean Medical Center, Brick, NJ; ²Hackensack Meridian Ocean Medical Center, Brick Township, NJ

Introduction: COVID-19 (coronavirus disease) is characterized by respiratory symptoms. Gastrointestinal involvement, on the other hand, is rather common, with a prevalence of 10% to 50%. Nausea, vomiting, diarrhoea, and abdominal pain are the most common gastrointestinal symptoms. Gastrointestinal perforation in association with COVID-19 is uncommonly reported in the literature. We report a case of bowel perforation and pancolitis in a patient with severe COVID-19 infection.

Case Description/Methods: A 58 year-old male patient presented with abdominal pain and non-bloody diarrhea of 2 weeks duration. Past medical history included chronic alcohol abuse with 6-8 drinks daily. Abdominal examination was positive for left quadrant tenderness. Laboratory results revealed BUN of 56 mmol/L, Creatinine 1.84 mg/dL, Sodium 134 mEq/L, Bicarbonate 18 mEq/L, Albumin 2.8 g/dL, AST 91 U/L, ALT 84 U/L, CRP of 32.43 mg/dL, ferritin 957.1 ng/mL, High D-Dimer of 7231 ng/mL, and a positive COVID-19 test. CT of abdomen revealed thickening of the colonic wall. He was treated for acute pancolitis with ciprofloxacin and metronidazole. COVID-19 was treated with remdesivir, dexamethasone, and lovenox. After two days, the patient's health deteriorated, he became unresponsive and lethargic. A repeat CT scan showed extensive free air, with pancolitis, pneumatosis, and perforation in the transverse colon. The patient was transferred to the operation room for total colectomy and ileostomy. The patient was in stable condition after the surgery and continued to improve.

Discussion: COVID-19 has been found to be associated with nausea and vomiting in 5.2% to 22.7% of cases, with a pooled prevalence of 7.8%. Abdominal pain is an uncommon symptom of COVID-19 infection with a range of 3.9 % to 6.8 % of the cases. While there have been cases where COVID-19 has led to GI bleeding, but GI perforation in association with COVID-19 is rarely reported in the literature. This will raise clinician’s suspicions and awareness of such complications, which require prompt diagnosis and early management to improve the patient's outcome.


Figure: Colon Ulcer related to severe COVID-19 infection


Disclosures:
Dina Alnabwani indicated no relevant financial relationships.
Anish Kumar Kanukuntla indicated no relevant financial relationships.
Priyaranjan Kata indicated no relevant financial relationships.
Pramil Cheriyath indicated no relevant financial relationships.
Chitra Lahoti indicated no relevant financial relationships.
Vinay Yalamanchi indicated no relevant financial relationships.


Dina Alnabwani, MD¹, Anish Kumar Kanukuntla, MD², Priyaranjan Kata, MD¹, Pramil Cheriyath, MD, MS¹, Chitra Lahoti, MD¹, Vinay Yalamanchi, DO¹. P1277 - A Rare Case of Bowel Perforation Secondary to COVID-19 Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.