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CE CT Abdomen with blue arrowhead showing leak of contrast from the small bowel lumen and White arrowhead showing air in the subcuteous tissue.
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COVID-19 workup panel revealed CRP - 47.34 mg/l, Procalcitonin 45.36 ng/mL, Serum ferritin - 184.62 ng/mL, Plasma d-Dimer -4.42 mug/ml, Interleukin 6 - >1528 pg/mL. Contrast enhanced computed tomogram (CECT) abdomen revealed features of bowel wall thickening involving small bowel loop, ascending colon, caecum and sigmoid colon with peri colonic fat stranding and pneumoperitoneum suggestive of multiple bowel injuries (Fig. 1).
Bowel perforation of size 2 x 2 cm at 110 cm from the duodenojejunal flexure.
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Intraoperative findings revealed multiple bowel perforations of size 2 x 2 cm at 110 cm, perforation of size 1 x 1 cm at 140 cm from the duodenojejunal flexure, another perforation of about 3 cm noted at sigmoid colon (Fig. 2, Fig. 3) with no associated solid organ injury.
Perforation of about 3 cm noted at sigmoid colon showing charring at circumference.
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Primary repair was done for small bowel and colonic perforation (Fig. 4).