Case Report: Duodenal Perforation In A Critically Ill Patient With Covid-19

Aims We report the case of a 54 - year old male who was admitted to our intensive care unit due to respiratory failure and COVID-19 disease. The patients’ comorbidities were allergic asthma and obesity; he was on no regular medication. On day 15 after admission to the ICU, invasive ventilation was started, and on day 19, melena, with a drop in hemoglobin level from 12.9 g/dl to 8.5 g/dl, was observed.

Methods In the emergency gastroscopy, three ulcerations were seen in the duodenal bulb. Two ulcerations showed visible vessels (Forrest IIa), and were treated with a standard hemoclip as well as an “Over-the-Scope-Clip” (OTSC, Ovesco). The third ulceration was covered by a large clot (F IIb). After mobilization of the clot, the ulceration was seen to have perforated into the retroperitoneum.

Results The patient underwent emergency surgery in which the perforation was sutured.

Conclusions Studies have shown a high risk for gastrointestinal complications, such as gastrointestinal ischemia and ileus in critically ill patients with COVID-19 disease. In this case, we postulate that critically ill patients with COVID-19 may have a higher risk of GI bleeding and ulcer perforation. However, it is unclear whether these complications can be specifically attributed to the underlying COVID-19 disease or the therapeutic anticoagulation, which all critically ill patients with COVID-19 recieve as standard of care. Further studies are needed to confirm or rule out these assumptions. Nevertheless, special attention should be paid to gastrointestinal complications in critically ill COVID-19 patients.

Citation Prinz F, Braun G, Ebigbo A et al. eP504 CASE REPORT: DUODENAL PERFORATION IN A CRITICALLY ILL PATIENT WITH COVID-19. Endoscopy 2021; 53: S265.

Publication History

Article published online:
19 March 2021