Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 12 , ISSUE 6 ( November-December, 2020 ) > List of Articles

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Bowel Perforation due to COVID-19: A Mini Review

Manisha V Ramani, Rajiv K Saxena, Chaitanya Indrani

Keywords : Bowel injury, Complications, COVID-19, Gastrointestinal manifestations, Jejunal perforation, Maternal death

Citation Information : Ramani MV, Saxena RK, Indrani C. Bowel Perforation due to COVID-19: A Mini Review. J South Asian Feder Obs Gynae 2020; 12 (6):427-431.

DOI: 10.5005/jp-journals-10006-1845

License: CC BY-NC 4.0

Published Online: 12-04-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The severe acute respiratory syndrome coronavirus-2 was initially believed to be an infection of only the respiratory system. It is now known to have many extrapulmonary affections including gastrointestinal symptoms associated with high mortality rates. An unusual presentation of bowel perforation in a patient who had recently undergone cesarean delivery prompted us to report this mini review of bowel perforations attributed to coronavirus. Case: Our patient, a 19-year-old primigravida, underwent an emergency cesarean section under spinal anesthesia. Intraoperative events and postoperative period were uneventful, and the patient was discharged on postoperative day 5. On the 10th postoperative day, the patient presented in septic shock to the emergency department with complaints of acute epigastric pain, vomiting, loose stools, and bilious discharge from the wound site. Oral contrast computed tomography was done, which revealed a proximal jejunal perforation. The patient was taken up for laparotomy followed by bowel repair with placement of intraperitoneal drains. Immediate postoperatively, the patient developed high-grade fever for which reverse transcription polymerase chain reaction (RT-PCR)_for COVID-19 was sent. The result for the same turned out to be positive. Twenty-four hours after the laparotomy, the intraperitoneal drains again started draining copious bilious discharge along with the deterioration of general condition of the patient. She expired on the third postoperative day. This was followed by a thorough research of the literature into possible etiologies for bowel perforation. In this mini review, we shall be discussing various case reports to determine the cause of such unusual presentation in our patient.


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  1. Lin L, Jiang X, Zhang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut 2020;69(6):997–1001. DOI: 10.1136/gutjnl-2020-321013.
  2. Gartland RM, Velmahos GC. Bowel necrosis in the setting of COVID-19 [published online ahead of print, 2020 May 3]. J Gastrointest Surg 2020;1–2. DOI: 10.1007/s11605-020-04632-4.
  3. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature 2020;579:265–269. DOI: 10.1038/s41586-020-2008-3.
  4. Zhang H, Kang Z, Gong H, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. BioRxiv 927806. Post online Jan 31. DOI: 10.1101/2020.01.30.927806.
  5. Parry AH, Wani AH, Yaseen M. Acute mesenteric ischemia in severe coronavirus-19 (COVID-19): possible mechanisms and diagnostic pathway. Letter to editor. Acad Radiol 2020;27(8):1190. DOI: 10.1016/j.acra.2020.05.016.
  6. Singhania N, Bansal S, Nimmatoori DP, et al. Current overview on hypercoagulability in COVID-19. Am J Cardiovasc Drugs 2020;20:393–403. DOI: 10.1007/s40256-020-00431-z.
  7. Mesdaghinia E, Abedzadeh-Kalahroudi M, Hedayati M, et al. Iatrogenic gastrointestinal injuries during obstetrical and gynecological operation. Arch Trauma Res 2013;2(2):81–84. DOI: 10.5812/atr.12088.
  8. Stany MP, Farley JH. Complications of gynecologic surgery. Surg Clin North Am 2008;88:343–359. DOI: 10.1016/j.suc.2007.12.004.
  9. Corrêa Neto I, Viana K, Silva M, et al. Perforated acute abdomen in a patient with COVID-19: an atypical manifestation of the disease. J Coloproctol 2020;40(3):269–272. DOI: 10.1016/j.jcol.2020.05.011.
  10. De Nardi P, Parolini D, Ripa M, et al. Bowel perforation in a COVID-19 patient: case report. Int J Colorectal Dis 2020;35(9):1797–1800. DOI: 10.1007/s00384-020-03627-6.
  11. Kangas-Dick A, Prien C, Rojas K, et al. Gastrointestinal perforation in a critically ill patient with COVID-19 pneumonia. SAGE Open Med Case Rep 2020;8:1–4. DOI: 10.1177/2050313X20940570.
  12. Bhayana R, Som A, Li M, et al. Abdominal imaging findings in COVID-19: preliminary observations. Radiology 2020;297(1):207–215. DOI: 10.1148/radiol.2020201908.
  13. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
  14. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720. DOI: 10.1056/NEJMoa2002032.
  15. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5.
  16. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18(4):844–847. DOI: 10.1111/jth.14768.
  17. Panigada M, Bottino N, Tagliabue P, et al. Hypercoagulability of COVID-19 patients in intensive care unit. A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost 2020;18(7):1738–1742. DOI: 10.1111/jth.14850.
  18. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395(10234):1417–1418. DOI: 10.1016/S0140-6736(20)30937-5.
  19. Jin X, Lian J, Hu J, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020;69(6):1002–1009. DOI: 10.1136/gutjnl-2020-320926.
  20. Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667–678. DOI: 10.1016/S2468-1253(20)30126-6.
  21. Gupta S, Jayant M, Kaushik R. Free tubercular perforation of the ileum. World J Emerg Med 2013;4(3):235–236. DOI: 10.5847/wjem.j.issn.1920-8642.2013.03.015.
  22. Jain S, Meena LN, Ram P. Surgical management and prognosis of perforation secondary to typhoid fever. Trop Gastroenterol 2016;37(2):123–128. DOI: 10.7869/tg.336.
  23. Freeman HJ. Spontaneous free perforation of the small intestine in Crohn's disease. Can J Gastroenterol 2002;16:23–27. DOI: 10.1155/2002/284958.
  24. Sakaguchi T, Tokuhara K, Nakatani K, et al. Laparoscopic management for spontaneous jejunal perforation caused by nonspecific ulcer: a case report. Int J Surg Case Rep 2017;39:309–312. DOI: 10.1016/j.ijscr.2017.08.048.
  25. Nahar S, Ranjan A. Observational study of small bowel perforation in a tertiary care hospital. Int Surg J 2017;4(8):2746–2750. DOI: 10.18203/2349-2902.isj20173411.
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