Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Med Arch. 2023 Apr;77(2):155-157. doi: 10.5455/medarh.2023.77.155-157.
Stress ulcers in the upper gastrointestinal tract can arise from pathologies related to erosive or inflammatory insults in critically ill patients. The relationship between stressful bodily events and the ischemia and perforation of stress ulcers is poorly understood.
We present a case of perforated stress ulcer following an abortion that was treated by dilatation and curettage (D&C) and complicated by a coronavirus disease 2019 (COVID-19) infection.
A 40-year-old lady presented to the emergency room complaining of diffuse abdominal pain, she was recently diagnosed with an incomplete abortion and managed via a D&C procedure in an external hospital. A computed tomography (CT) scan was done at our center for the abdomen and pelvis, showing extensive pneumoperitoneum, which brought the radiologist's attention to suspect a small bowel perforation presumably accompanying a uterine perforation secondary to the D&C. There were no obvious signs of pelvic small bowel perforation in the initial CT images. The perforated duodenal stress ulcer was diagnosed the next day by a new CT scan following oral contrast ingestion and managed surgically by repair and omental patch, and no other bowel perforations were found upon surgical exploration. After the surgery, the patient was diagnosed with COVID-19, and her clinical status deteriorated gradually during the following week, and she passed away from a cardiac arrest.
It is unclear whether septic abortion or COVID-19 has resulted in stress ulcer perforation in our patient. This case report highlights the importance of raising early suspicion in the diagnosis of stress ulcer perforation in critically ill patients to reduce the risk of morbidity and mortality.
在上消化道，应激性溃疡可由危重病患者的侵蚀性或炎症性损伤相关的病理学引起。应激性躯体事件与应激性溃疡的缺血和穿孔之间的关系尚未得到充分理解。
我们报告了一例因流产后行扩张刮宫术（D&C）而发生穿孔性应激性溃疡的病例，且并发 2019 冠状病毒病（COVID-19）感染。
一名 40 岁的女性因弥漫性腹痛就诊于急诊室，她最近被诊断为不完全性流产，并在一家外院接受了 D&C 治疗。在我院进行的腹部和骨盆 CT 扫描显示广泛的气腹，这引起了放射科医生的注意，怀疑存在小肠穿孔，可能伴随 D&C 导致的子宫穿孔。在最初的 CT 图像中没有明显的盆腔小肠穿孔迹象。第二天，在口服造影后进行的新 CT 扫描诊断为穿孔性十二指肠应激性溃疡，并通过手术进行了修复和网膜补丁治疗，在手术探查中未发现其他肠穿孔。手术后，患者被诊断为 COVID-19，她的临床状况在接下来的一周逐渐恶化，并因心脏骤停去世。
尚不清楚是感染性流产还是 COVID-19 导致了我们患者的应激性溃疡穿孔。本病例报告强调了在危重病患者中早期怀疑应激性溃疡穿孔的重要性，以降低发病率和死亡率的风险。
