2. CASE PRESENTATION
A 57-year-old female presented to the emergency department with a complaint of acute abdominal pain for three days. The pain was acute in onset, crampy, non-radiating, and increasing in severity, which used to be aggravated after ingestion of food and accompanied with palpitation and vomiting with no known resolving factors. She had three episodes of vomiting during the last two days. The patient had not passed stool or flatus since the last two days prior to hospitalization. The patient had no past medical history of diabetes, hypertension, hyperlipidemia, or prior thrombotic events. However, she was a chronic smoker and on medication for COPD for the past ten years.
On her arrival to the emergency department, her pulse rate was 130 beats per minute, regular; oxygen saturation 85% on room air; blood pressure 95/70 mmHg, body temperature 38.7° C, and respiratory rate 22 breaths/min. The baseline electrocardiography showed tachycardia with sinus rhythm. Screening for COVID-19 was done using a rapid antigen test kit and was found to be positive. It was followed by a reverse transcription-polymerase chain reaction (RT-PCR) test, which was positive as well. On her physical examination, her abdomen was distended with diffuse tenderness. There was diffuse guarding and rigidity all over the abdomen. Bowel sounds were absent. Digital rectal examination revealed a normal sphincter tone with a collapsed rectum and absent fecal stain on the gloved finger.
She was immediately administered crystalloids and supplemental oxygen at 4 litres/min. Nasogastric tube decompression and Foley catheterization were done. Her laboratory parameters showed leukocytosis with raised amylase. Liver function test revealed total bilirubin 2.20 mg/dL, conjugated bilirubin 0.9 mg/dL and alkaline phosphatase 674 U/L (Table 1). Her Arterial Blood Gas (ABG) analysis showed metabolic acidosis with raised lactate level.