Non-surgical pneumoperitoneum in a patient with COVID-19

Abstract

Introduction. Pneumoperitoneum is defined as the presence of air in the abdominal cavity. One of the non-surgical causes of pneumoperitoneum is mechanical ventilation, with sporadic cases caused by the pandemic period and the management of COVID-19 patients.Purpose. Management of spontaneous pneumoperitoneum in COVID-19 patient.Material and methods. Woman, 64 years old, hospitalized in serious condition in ATI, COVID-19 confirmed, 4 days after the onset. Progressive worsening tachypnea - 26-30 breaths per minute, 84% SPO2- , NIV intolerance. Difficult intubation. Postintubation - sudden increase in volume of the abdomen, disappearance of liver dullness, diffuse eardrum. BP 75 / 47mmHg, HR 134bpm, SPO2 45%, cardiotonics were administered. Results. The absence of the ulcer anamnesis and the favorable circumstances establish the suspicion of non-surgical pneumoperitoneum. Infraumbilical laparocentesis: pressurized air was evacuated. BP 102/65 mmHg, HR at 74beats per minute, SO2 89-91%. No peritoneal signs were detected. Drain extraction on the 3rd day. Death on the 39th day after admission.Conclusions. The diagnosis of non-surgical pneumoperitoneum should be considered in COVID-19 patients on oxygen support, being a rare nosology, but with major repercussions in case of poor management.