A case report on spontaneous hemoperitoneum in COVID-19 pati
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• Young adult COVID-19 patient presented with acute abdomen.

• Evaluation of patient revealed splenomegaly, splenic rupture and hemoperitoneum.

• Patient recover with conservative management.

Coronavirus disease (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients commonly present with respiratory tract symptoms and fever. However, two-third are asymptomatic and unusual presentation is evolving. This has cause management dilemmas among physicians.

A 32years old serving soldier with no known co-morbidities presented in the emergency department (ED) of the institute with a fever for 6 days. The fever was associated with chills and rigors. He was evaluated in the ED by attending a consultant physician and surgeon on duty. He was admitted in the COVID-19 isolation ward and subjected to thorough clinical, laboratory, and imaging studies. The maximum temperature recorded was 103 °F, blood pressure was 110/70 mmHg, and oxygen saturation in room air was 92 %. His nasopharyngeal swab specimen was tested positive for SARS-CoV-2. He was under symptomatic treatment for fever. The urine and blood sample send for culture showed no growth of the organism. On the third day of admission, his cell counts tend to normalize but there was a progressive fall in blood hemoglobin level from 14.1 gm/dl to 7.3 gm/dl.

On the same day, the patient complained of moderate to severe periumbilical pain without features of peritonitis. The abdominal ultrasound showed the intraperitoneal collection in perisplenic space. Contrast computed tomography study (CECT-abdomen pelvis) images revealed contrast extravasation from the breached capsule in the upper pole of the spleen during the porto-venous phase, which is suggestive of infarct laceration of splenic. Cranio-caudally the spleen measure 14 cm and the splenic index is 1048. There was moderate intraperitoneal collection localized in perisplenic space, perihepatic space, and pelvic cavity. The patient developed generalized maculopapular rash without itching. He was transferred to COVID-19 intensive care unit (ICU) with monitoring of vitals, urine output, and serial hemoglobin and was transfused with three-unit of packed RBC. Besides, he was given symptomatic and supportive care. Patient remain clinically stable during ICU admission and the hemoperitoneum resolved spontaneously on 7th day of admission.