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Inicio Cirugía Española (English Edition) Pathogenesis of pneumoperitoneum in a COVID-19 patients
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Vol. 99. Issue 6.
Pages 476-477 (June - July 2021)
Vol. 99. Issue 6.
Pages 476-477 (June - July 2021)
Letter to the Editor
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Pathogenesis of pneumoperitoneum in a COVID-19 patients
Etiopatogenia de neumoperitoneo en pacientes COVID-19
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Javier A. Cienfuegosa,b,c, Ana Almeidaa,
Corresponding author
aavargas@unav.es

Corresponding author.
, Daniel Alisedaa, Fernando Rotellara
a Departamento de Cirugía General y Digestiva, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Instituto de Investigación Sanitaria de Navarra (IdisNA), Pamplona, Navarra, Spain
c CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
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Ignacio Antonio Gemio del Rey, Roberto de la Plaza Llamas, José Manuel Ramia, Aníbal Armando Medina Velasco
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To the Editor:

Gemio del Rey et al.1 describe a case of spontaneous pneumoperitoneum in a patient with bilateral SARS-CoV-2 pneumonia, with no signs of a systemic inflammatory response and having ruled out an intra-abdominal cause. The authors wisely associated pneumoperitoneum with mechanical ventilation.

In patients with coronavirus 2019 (COVID-19), intestinal pneumatosis and pneumoperitoneum have occasionally been described without observed intestinal perforation.2–4 In these case, the etiopathogenic cause has been related with direct damage to the intestinal mucosa by SARS-CoV-2—the intestinal epithelium has abundant receptors for angiotensin converting enzyme-2 (ACE-2)—and to ischemic mechanisms secondary to arterial and venous splanchnic thrombosis.5,6

One of the most striking phenomena in COVID-19 patients are thromboembolic complications at multiple levels, secondary to the severe systemic inflammatory response induced by SARS-CoV-2.7,8 Therefore, antithrombotic prophylaxis is recommended in most patients with moderate or severe COVID-19.9,10

Although the case described by Gemio del Rey et al.1 does not report the progression of fibrinogen or D-dimer levels, we feel that this etiopathogenic possibility should be considered in COVID-19 patients.

References
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I.A. Gemio del Rey, R. de la Plaza Llamas, J.M. Ramia, A.A. Medina Velasco, D.A. Díaz Candelas.
Non-surgical spontaneous pneumoperitoneum in a COVID-19 positive patient with severe bilateral pneumonia.
[2]
J. Kielty, W.P. Duggan, M. O’Dwyer.
Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2.
Ann R Coll Surg Engl, 102 (2020), pp. E145-E147
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A.J. Láinez Ramos-Bossini, M del C. Pérez García, M.Á. Pérez Rosillo, R. Gálvez López.
Spontaneous pneumoperitoneum and pneumatosis intestinalis as sole manifestations of a COVID-19 infection. An extremely rare complication.
Rev Esp Enferm Dig, (2020), pp. 113
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K. Lui, M.P. Wilson, G. Low.
Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review.
Abdom Radiol, (2020), pp. 1-7
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COVID-19, coronavirus, SARS-CoV-2 and the small bowel.
Rev Esp Enferm Dig, 112 (2020), pp. 383-388
[6]
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Evidence for gastrointestinal infection of SARS-CoV-2.
Gastroenterology, 158 (2020), pp. 1831.e3
[7]
D.C. Fajgenbaum, C.H. June.
Cytokine storm.
N Engl J Med, 383 (2020), pp. 2255-2273
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L. Nicolai, A. Leunig, S. Brambs, R. Kaiser, T. Weinberger, M. Weigand, et al.
Immunothrombotic dysregulation in COVID-19 pneumonia is associated with respiratory failure and coagulopathy.
Circulation, 142 (2020), pp. 1176-1189
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D.A. Berlin, R.M. Gulick, F.J. Martinez.
Severe Covid-19.
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B. Bikdeli, M.V. Madhavan, D. Jimenez, T. Chuich, I. Dreyfus, E. Driggin, et al.
COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up.

Please cite this article as: Cienfuegos JA, Almeida A, Aliseda D, Rotellar F. Etiopatogenia de neumoperitoneo en pacientes COVID-19. Cir Esp. 2021;99:476–477.

Copyright © 2021. AEC
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