Gemio del Rey et al.1 describe a case of spontaneous pneumoperitoneum in a patient with bilateral SARS-CoV-2 pneumonia, with no signs of a systemic inflammatory response and having ruled out an intra-abdominal cause. The authors wisely associated pneumoperitoneum with mechanical ventilation.
In patients with coronavirus 2019 (COVID-19), intestinal pneumatosis and pneumoperitoneum have occasionally been described without observed intestinal perforation.2–4 In these case, the etiopathogenic cause has been related with direct damage to the intestinal mucosa by SARS-CoV-2—the intestinal epithelium has abundant receptors for angiotensin converting enzyme-2 (ACE-2)—and to ischemic mechanisms secondary to arterial and venous splanchnic thrombosis.5,6
One of the most striking phenomena in COVID-19 patients are thromboembolic complications at multiple levels, secondary to the severe systemic inflammatory response induced by SARS-CoV-2.7,8 Therefore, antithrombotic prophylaxis is recommended in most patients with moderate or severe COVID-19.9,10
Although the case described by Gemio del Rey et al.1 does not report the progression of fibrinogen or D-dimer levels, we feel that this etiopathogenic possibility should be considered in COVID-19 patients.
Please cite this article as: Cienfuegos JA, Almeida A, Aliseda D, Rotellar F. Etiopatogenia de neumoperitoneo en pacientes COVID-19. Cir Esp. 2021;99:476–477.