Case Report: Paralytic Ileus: A Potential Extrapulmonary Manifestation of Severe COVID-19

• Published in: The American journal of tropical medicine and hygiene 2020-10, Vol.103 (4), p.1600-1603
• Main Authors: Ibrahim, Yassmin S, Karuppasamy, Gowri, Parambil, Jessiya V, Alsoub, Hussam, Al-Shokri, Shaikha D
• Format: Article
• Language: English
• Subjects: Adult; Betacoronavirus - pathogenicity; Biomarkers - metabolism; Case reports; Coronavirus Infections - diagnostic imaging; Coronavirus Infections - physiopathology; Coronavirus Infections - therapy; Coronavirus Infections - virology; Coronaviruses; COVID-19; Humans; Intestinal obstruction; Intestinal Perforation - diagnostic imaging; Intestinal Perforation - physiopathology; Intestinal Perforation - therapy; Intestinal Perforation - virology; Intestinal Pseudo-Obstruction - diagnostic imaging; Intestinal Pseudo-Obstruction - physiopathology; Intestinal Pseudo-Obstruction - therapy; Intestinal Pseudo-Obstruction - virology; Liver - enzymology; Liver - pathology; Liver - virology; Male; Pancreatitis - diagnostic imaging; Pancreatitis - physiopathology; Pancreatitis - therapy; Pancreatitis - virology; Pandemics; Pneumonia; Pneumonia, Viral - diagnostic imaging; Pneumonia, Viral - physiopathology; Pneumonia, Viral - therapy; Pneumonia, Viral - virology; Positive-Pressure Respiration - methods; Renal Dialysis; Renal Insufficiency - diagnostic imaging; Renal Insufficiency - physiopathology; Renal Insufficiency - therapy; Renal Insufficiency - virology; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Tomography, X-Ray Computed; Transaminases - metabolism
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.20-0894

The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.