Can COVID-19 Cause Intestinal Perforation? A Report of 2 Cases

BACKGROUND: The occurrence of perforated viscera as a complication of Coronavirus Disease 2019 (COVID-19) is a rare entity. We report 2 patients diagnosed with COVID-19 who developed large-bowel perforation. One patient was treated conservatively and the other required surgical intervention.
CASE REPORT: Case 1: A 37-year-old man was admitted to the Intensive Care Unit (ICU) due to COVID-19 pneumonia. He was started on intravenous dexamethasone on day 6. On day 12 after admission, he developed painless abdominal distension. Contrast-enhanced computed tomography showed perforation in the ascending colon. His laboratory workup revealed a normal leukocyte count. We elected to manage him conservatively and he was discharged home in a stable condition on day 28 after admission.
Case 2: A 50-year-old diabetic woman was admitted to the ICU because of COVID-19 pneumonia. On day 17, she developed abdominal distension with evidence of peritonitis and leukocytosis. Contrast-enhanced computed tomography revealed pneumoperitoneum, pneumatosis intestinalis in the small bowel wall, and gas in the portal vein. During exploration, perforations were identified in the cecum, ascending colon, and hepatic flexure. The patient underwent right hemicolectomy with smooth postoperative recovery. The histopathology report showed multiple ischemic ulcerations with foci of transmural perforations.
CONCLUSIONS: Intestinal symptoms and surgery-requiring abdominal conditions can occur in COVID-19, as well colonic perforation in severe forms of the disease, which increases morbidity and mortality. Close abdominal evaluation is an important element in the management of such patients, as well as timely action if these complications occur.

Keywords: Abdomen, Acute, Colectomy, Intestinal Perforation