COVID-19 and Gastrointestinal Manifestation: A Case Report on Colonic Perforation in 91-year- old man with Severe COVID-19 Infection

Abstract

A-91-year-old man had severe Covid-19 infection as he had bilateral severe pneumonia with SaO2 85% on air. He was treated with antibiotics, oxygen, dexamethasone and convalescent plasma therapy. Following recovery from respiratory failure, on day 28 symptom onset, he had loose motion and abdominal distension without abdominal pain. Then, he suddenly developed septic shock and features of peritonism. CT abdomen revealed pneumoperitoneum. After resuscitation with fluids, inotropes and antibiotics, emergency laparotomy was done. An area of perforation at colon with mucosal hemorrhage was seen. Right hemicolectomy was done. Histology showed mucosal oedema, infiltration with inflammatory cells mainly polymorphs and lymphocytes, congested vessels with areas of hemorrhage in the mucosa. Post-operative period was critical; septic shock required two inotropes, blood transfusion and fluids. It was complicated by ARDS and multiorgan failure.