Publication:

A rare case of COVID-19 related stomach gangrene after an abortion: a case report

A 25 year old female had presented with complaints of severe epigastric pain with abdominal distension and vomiting for 4 days. She had undergone medical termination of pregnancy for a missed abortion of 5 weeks of gestation 5 days prior. The patient's COVID-19 RT PCR was found to be positive. Her CECT showed covid related changes in bilateral lungs and pneumoperitoneum. Stomach was distended. Other small bowels appeared normal. Patient underwent emergency laparotomy. Two third of stomach appeared gangrenous with a perforation in the posterior wall of stomach so she underwent a subtotal gastrectomy. She had features of covid associated coagulopathy (CAC) with high D-dimer (520 ng/ml), thrombocytosis (up to 705,000/mcl), high activated partial thromboplastin time (aPTT) (up to 55.6 sec) and high prothrombin time (PT) (up to 27.9 sec and INR 2.11) for which low molecular heparin was given. Stomach is a highly vascular organ. Gangrene of the stomach has been very rarely reported. CAC is known to lead to both arterial thrombus and venous thromboembolism. COVID-19 related abortions have also been reported though the exact mechanism not certain but CAC could be one of them.