Bowel Ischemia in a Patient With SARS CoV-2-Like Illness and Negative Real-Time Reverse Transcription Polymerase Chain Reaction Test Results During the Peak of the Pandemic

Almafreji, Ibrahim; Ranganath, Sathyaprakash

An 83-year-old man presented to the emergency department (ED) during the peak of the first wave of the SARS CoV-2 (COVID-19) pandemic with severe abdominal pain, mimicking a severe abdominal pathology. He was found to have features suggestive of COVID-19 infection radiologically, with no leaking aortic aneurysm, bowel ischemia, pancreatitis, or perforation. With worsening symptoms, a repeat computer tomography (CT) scan four days later showed features of bowel ischemia, and he underwent a laparotomy and right hemicolectomy. Four real-time reverse transcription-polymerase chain reaction (rRT-PCR) tests were negative. He was still considered to be infected with COVID-19 and died from complications arising from multi-organ failure. This case highlights an atypical presentation of a possible COVID-19 infection, the urgency to have additional diagnostic tests apart from rRT-PCR, and the necessity to use the appropriate personal protective equipment (PPE) during the pandemic.