INTESTINAL PNEUMATOSIS IN A PATIENT WITH COVID-19 INFECTION EVOLVING WITH COMPLICATIONS AND INDICATION FOR AN EMERGENCY SURGICAL APPROACH - CASE REPORT

• DOI: 10.22533/at.ed.1593482330065

• Palavras-chave: Pneumatosis intestinalis, COVID-19, computed tomography and exploratory laparotomy.

• Keywords: Pneumatosis intestinalis, COVID-19, computed tomography and exploratory laparotomy.

• Abstract:

  The presence of air in the intestinal wall, termed pneumatosis intestinalis (pneumatosis intestinalis - IP), is a frequent radiological finding that presents a multifactorial etiology. Individuals presenting with this alteration are mostly asymptomatic; however, in certain situations, the condition can develop into serious complications requiring immediate intervention. The present report describes a 65-year-old male, alcoholic and smoker, in the presence of COVID-19 infection, presenting with acute abdomen with surgical indication. At exploratory laparotomy, diffuse intestinal pneumatosis and volvulus of a previous latero-lateral anastomosis were evidenced, with distention upstream from the ileum to the cecum and with an aspect of ischemia. Postoperatively, he progressed with hemodynamic instability requiring admission to the intensive care unit (ICU). He responded well to therapy and was discharged from the hospital on the 10th postoperative day. In pneumatosis intestinalis (PI), it is important to elucidate its etiology - idiopathic or secondary to mechanical, infectious, and autoimmune causes - to adopt the appropriate therapy. COVID-19 infection, when severe, may present with extrapulmonary symptoms, and it is not yet known whether these can be used as clinical markers of higher levels of viremia or from a secondary pathophysiological process. Although the pathophysiological relationship between COVID-19 infection and PI is still unknown, one of the most accepted theories states that the release of gas from the alveolar lesion can travel through the mediastinum and retroperitoneum reaching the intestinal wall. Thus, it is evident that a better study of the relationship between COVID-19 infection and its repercussions on the gastrointestinal tract, especially with respect to pneumatosis intestinalis, is necessary.