Pneumoperitoneum as a Rare Clinical Manifestation in two Patients with COVID-19: A Case Series Study

Background & Aims: Pneumoperitoneum is characterized by the presence of air inside the peritoneal cavity, which may be the result
of a perforated hollow organ in GI (Gastrointestinal) tract, requiring emergency surgical intervention. However, pneumoperitoneum is
known to be spontaneous, nonsurgical, or unexplained in some cases without perforation. The present study is a case series study,
introducing two cases of pneumoperitoneum in the patients with COVID-19.
Case presentation: The first case was a 70-year-old woman with COVID-19 who underwent laparotomy, and no perforation was
detected in her as the source of pneumoperitoneum under direct observation. The second case was a four-year-old girl who was referred
to hospital after a car accident as pedestrian. After taking a CT scan, COVID-19 was diagnosed accidentally without any previous sign.
After diagnosing pneumoperitoneum, since there was no symptom of perforation or peritonitis, the patient was actively monitored
during the hospitalization period and discharged on day 8 of hospitalization in a general good condition.
Discussion & Conclusion: Evidence from a previous study suggests that coronavirus has a high propensity to gastrointestinal tract.
Enteropathic viruses can directly damage the intestinal mucosa and cause gastrointestinal complaints in the patients. Invasion of the
virus into the intestinal wall can increase the permeability of the intestinal wall, leading to easier invasion of pathogens over the large
intestine tract and intestinal complaints (including pneumatosis) by reducing the function of intestinal barrier. Increasing permeability
of the intestinal wall may be a factor of pneumoperitoneum