S2803 Bizarre Bariatric Complication With Small Bowel Obstruction in a COVID-19 Patient With Acute Abdomen

Abstract

INTRODUCTION: Gastrointestinal emergencies in the novel coronavirus pandemic present as acute abdomen in 4-5% of patients as gathered from emerging studies. Nausea, abdominal pain, diarrhea, rectal bleeding, dysgeusia, anorexia and jaundice have been recorded in these patients. Additionally there are cases with hemorrhagic gastritis, ischemia of bowel, and hepatitis often due to systemic immune complex phenomenon and thrombosis. We report a rare case of small bowel obstruction in a Covid-19 patient with a dislodged and migrated EG junction stent, initially placed to circumvent a leak at a prior gastrojejunal (GJ) bypass surgical revision, and then presenting to the emergency room with acute abdomen. CASE DESCRIPTION/METHODS: A 54 year old woman underwent a routine laparoscopic GJ revision in 2/2020 after which she developed a GJ leak 2 weeks later warranting an esophageal stent placement . She was then discharged home, at the height of the Covid-19 outbreak in a pandemic hotspot. She developed a small intra abdominal abscess post op 2 weeks warranting hospitalization for drainage and discharged on antibiotics. 2 months later, she presented with nausea, malaise, vomiting and diarrhea followed by worsening RLQ pain. An Abdominal CT w/ contrast revealed an impacted stent in the distal ileum with localized perforation and obstruction. After reporting generalized body aches and malaise at presentation, PCR testing revealed a positive Covid19 status. She underwent a successful emergency laparoscopic stent retrieval and repair, with no post op complications. DISCUSSION: Covid19 gastrointestinal emergencies are common, and varied with a favorable prognosis in respect to initial presentation. Our patient had subtle nausea, emesis and enteritis, as noted in 10–20% of patients with similar Covid presentation, which likely led to stent dislodgement and distal migration with subsequent bowel obstruction. Fortunately, her clinical course was mild so she was managed with optimal laparoscopic retrieval and supportive medical therapy after which she was successfully discharged from the hospital. Our case is unique in that an acute Covid19 case presenting concomitantly with post bariatric stent migration and bowel obstruction was successfully managed in a standard fashion during the height of a pandemic in a hotspot with stifling restrictions in place for routine emergencies. Though the exposure risk is high for medical staff, all such patients should be optimally managed like any Covid negative patients for optimal outcomes.Figure 1.: Migrated esophageal stent in the right lower quadrant.