Conservative Management of a Hollow Viscus Perforation in a Covid-19 Positive Patient

Abstract

Background: Spontaneous perforation of hollow viscous, following prolonged periods of fasting is usually seen in the first part of the duodenum. Surgical treatment is the gold standard therapeutic option. Mortality of around 8 to 25 % is seen and is usually associated with delayed diagnosis due to vague symptoms or due to delayed presentation. Several reports have been published on the conservative management of duodenal perforation. Aim: Here, we present a case with suspected duodenal perforation with Covid19 positive status, at Silchar Medical College, Assam, India. Case Presentation: Here, we present a 45 year old hypertensive male with acute onset of pain abdomen, nausea and abdominal distension for two days, in hemodynamic shock, diagnosed to be a case of hollow viscus perforation, suspected to be duodenal perforation with Covid19 positive status. He was resuscitated and managed conservatively with Ultrasonography guided insertion of a tube drain and symptomatic management of Covid19 was done. Results: Full recovery of the patient after a period of 21 days hospital stay and uneventful discharge from the hospital followed. Conclusion: Prompt drainage of secretions and prevention of accumulation of septic foci, under the cover of antibiotics, and acid suppressants is an alternative to surgical therapy in a case of duodenal perforation with Covid 19 positive status with inoperability due to hemodynamic unstability.