A Case Report of Bowel Perforation in a Gravid COVID-19 Patient.

IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL
A T Guiritan, J G Cataluña
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引用次数: 0

Abstract

Background: Bowel perforation in a pregnant patient with COVID-19 infection is a rarely reported complication. With the uncovering of the different treatment modalities and complications of this disease, this case highlights diagnostic and therapeutic dilemmas and limitations in a special population. Clinical Presentation. A 35-year-old female, Gravida 2 Para 1 at 31 weeks age of gestation (AOG) who underwent cesarean section for nonreassuring fetal status in 2019, was admitted for severe COVID-19 infection presenting with dyspnea. During her hospitalization, she developed progressive dyspnea from worsening of COVID-19 infection. Patient was eventually intubated and was given a total of two doses of tocilizumab, adequate antibiotic treatment, remdesivir, and dexamethasone. An emergency repeat cesarean section was performed due to maternal deterioration and poor variability of the fetus. She delivered to a live preterm baby girl, with an Apgar score of 1 and 7 on the 1st and 5th minute of life respectively. During the postoperative days, patient remained intubated and sedated. Increasing residuals were noted per nasogastric tube (NGT). Serial scout film of the abdomen (SFA) and medical management were performed. Upon weaning from sedation, patient complained of right lower quadrant pain. A whole abdominal computed tomography (CT) scan with contrast was requested which revealed large bowel obstruction. Patient was referred to surgery service. Upon assessment, abdomen was noted to be rigid with guarding during palpation. A scout film of the abdomen was requested and revealed extensive amount of pneumoperitoneum with scanty to absent colonic gas suggestive of bowel perforation. Patient underwent emergency exploratory laparotomy. Upon opening the peritoneum, free air was evacuated. Approximately 1.4 liters of fecaloid peritoneal fluid was suctioned and adhesive band was noted at the pelvic area. A 2 cm full thickness perforation at the cecum with 17 cm serosal tear from the cecum to ascending colon was noted. Bowel loops proximal to the perforation were dilated. Nasogastric tube was inserted for bowel decompression. Right hemicolectomy was performed. Specimen was sent for histopathology. Acute inflammatory cells infiltrating the blood vessels and possible microthrombi and beginning thrombus formation were noted in the subserosa. Patient eventually expired on the 14th hospital day from sepsis.

Conclusion: This case highlights a rarely reported complication of COVID-19 infection. Confluence of factors that predisposed the patient include pregnancy, COVID-19 infection, use of tocilizumab, and recent surgery. High index of suspicion is vital in the management and improvement of outcomes.

COVID-19妊娠患者肠穿孔1例报告。
背景:COVID-19感染孕妇肠穿孔是一种罕见的并发症。随着这种疾病不同治疗方式和并发症的发现,本病例突出了在特殊人群中诊断和治疗的困境和局限性。临床表现。一名35岁女性,妊娠31周龄(AOG),因胎儿状态不稳定于2019年接受剖宫产手术,因严重感染COVID-19并出现呼吸困难入院。住院期间,她因COVID-19感染恶化而出现进行性呼吸困难。患者最终插管并给予两剂托珠单抗、适当的抗生素治疗、瑞德西韦和地塞米松。由于产妇病情恶化和胎儿变异性差,进行了紧急重复剖宫产。她生下了一个活的早产女婴,阿普加评分分别为1分和7分,分别在生命的第1分钟和第5分钟。术后几天,患者保持插管和镇静。每根鼻胃管(NGT)的残留量增加。进行了连续腹部侦察片(SFA)和医疗处理。停用镇静剂后,患者主诉右下腹疼痛。要求全腹部电脑断层扫描(CT)与造影剂,发现大肠梗阻。病人被转介到外科。经评估,腹部在触诊时被注意到是刚性的。要求对腹部进行侦察片检查,发现大量气腹,结肠气体很少或不存在,提示肠穿孔。病人接受了紧急剖腹探查术。打开腹膜后,排出游离空气。抽取约1.4升粪样腹膜液,并在盆腔区域发现粘连带。盲肠2厘米全层穿孔,盲肠至升结肠17厘米浆膜撕裂。靠近穿孔处的肠袢扩张。插入鼻胃管进行肠减压。行右半结肠切除术。标本送组织病理检查。浆膜下可见急性炎症细胞浸润血管,可能有微血栓和开始形成血栓。病人最终在第14天因败血症死亡。结论:该病例突出了一种罕见的COVID-19感染并发症。导致患者易感的因素包括妊娠、COVID-19感染、使用托珠单抗和近期手术。高怀疑指数对于管理和改善结果至关重要。
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来源期刊
Case Reports in Medicine
Case Reports in Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
1.70
自引率
0.00%
发文量
53
审稿时长
13 weeks
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