Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang, China.
BMC Infect Dis. 2024 Aug 8;24(1):801. doi: 10.1186/s12879-024-09720-3.
With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications.
A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease.
Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.
随着 2019 年冠状病毒病（COVID-19）的流行，在世界范围内发现了许多重症病例。在此，报告了一例同时并发纵隔气肿、气腹和肠穿孔的病例。该病例是首例关于 COVID-19 引起相关并发症的报告。
一名 74 岁女性患者因 COVID-19 住院。影像学复查时意外发现气漏。考虑到患者的主观感觉不明显，早期给予保守治疗，最终手术证实为乙状结肠穿孔。最后，由于患者无法脱离呼吸机，家属放弃了治疗。巧合的是，患者的肾脏解剖位置也异常。这种情况导致了异常的气漏方向和腹膜炎的非典型表现，也是导致疾病延迟诊断和治疗的重要原因之一。
临床医生应警惕 COVID-19 患者自发性胃肠道穿孔，尤其是那些正在接受糖皮质激素和托珠单抗治疗的患者。分享该病例是为了强调 COVID-19 这种罕见且致命的肺外表现，并进一步帮助临床医生提高认识，及时进行影像学检查和多学科干预，以便于早期发现、诊断和治疗，降低死亡率。
