Perforated pyloric and acute pancreatitis in a patient with COVID-19 without respiratory symptoms: a case report
DOI:
https://doi.org/10.20453/rmh.v37i3.6478Keywords:
COVID-19, pancreatitis, peptic ulcer, critical care, case reportsAbstract
The relationship among COVID-19, acute pancreatitis, and gastrointestinal perforation remains uncertain. We report a 53-year-old woman without respiratory symptoms who presented with sudden abdominal pain, hypotension (89/52 mmHg), tachycardia, and fever. Laboratory tests showed hemoconcentration, acute kidney injury, and markedly elevated amylase and lipase. Computed tomography demonstrated pneumoperitoneum and free fluid; laparotomy revealed an approximately 3.5-cm perforated pyloric ulcer, which was treated with primary repair and pyloroplasty. Histopathology showed transmural wall disruption, necrosis, mixed inflammatory infiltrate, and fibrinopurulent exudate; Helicobacter pylori was not investigated. SARS-CoV-2 antigen test was positive, and D-dimer, ferritin, and interleukin-6 concentrations were elevated. The patient required six days of intensive care, underwent no reoperation, and was discharged alive after 14 days in hospital. The temporal coexistence is compatible with a possible contribution from COVID-19-associated inflammation but does not establish causality; an unconfirmed peptic etiology and hypoperfusion remain alternative explanations.
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Copyright (c) 2026 Jorge Luis Vélez-Páez, Hugo Arturo Tirapé-Castro, Erick Omar Tutin-Miniguano, Manuel Humberto Gallegos-Paredes, Darwin Daniel Campos-González
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