Postoperative multiple perforations of the small bowel in a patient with COVID-19 – case report
Authors:   Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania; 2nd General Surgery Clinic, Emergency County Clinical Hospital, Craiova, Romania, Dumitrescu Theodor Viorel , Meşină Cristian ,   Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania; 2nd General Surgery Clinic, Emergency County Clinical Hospital, Craiova, Romania, Ciorbagiu Mihai Călin ,   Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania; 2nd General Surgery Clinic, Emergency County Clinical Hospital, Craiova, Romania, Lascu Luana-Corina ,   Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Romania, Honţaru Sorina Octavia ,   Department of Health Care and Physiotherapy, Faculty of Sciences, Physical Education and Informatics, University Center of Piteşti, National University for Science and Technology Politehnica Bucharest, Romania, Ionovici Nina ,   Department of Occupational Medicine, University of Medicine and Pharmacy of Craiova, Romania, Mogoantă Laurenţiu ,   Department of Histology, University of Medicine and Pharmacy of Craiova, Romania; Romanian Academy of Medical Sciences, Craiova Subsidiary, Romania, Mogoantă Stelian Ştefăniţă ,   Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania; 3rd General Surgery Clinic, Emergency County Clinical Hospital, Craiova, Romania
Published: November 2024

During the coronavirus disease 2019 (COVID-19) pandemic, the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented quite a diverse symptomatology, in addition to respiratory symptoms, while other clinical signs such as thrombosis, postoperative hemorrhages, acute kidney or liver failure, digestive disorders (vomiting and diarrheal stools) were also reported. We present the case of a patient diagnosed with transverse colon neoplasm and asymptomatic SARS-CoV-2 infection, who presented to the Emergency Room (ER) of the Emergency County Clinical Hospital, Craiova, Romania, with a clinical picture of low intestinal occlusion. Surgery was decided and a right hemicolectomy extended to the left, with terminal ileostomy performed. The postoperative evolution was favorable, with the resumption of intestinal transit and discharge on the third postoperative day. The patient returned to the ER Department on the fifth day after surgery, with diffuse abdominal pain, absence of intestinal transit and flatulence. Clinical examination of the abdomen revealed the presence of bloating sounds on palpation. Emergency laparotomy was again performed with the suspicion of postoperative occlusion and five perforations were found in the small bowel, associated with fecaloid peritonitis and mechanic-inflammatory occlusion. The perforations were without any obvious lesion substrate, four of them being located on the jejunum and one on the terminal ileum. The histopathological examination revealed hemorrhage and recent transmural thrombosis on the intestinal wall, most likely caused by COVID-19. Without any respiratory symptoms, the COVID-19 infection caused multiple intestinal lesions, leading to peritonitis and septic shock, followed by the patient’s death.