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.