https://doi.org/10.4081/ecj.2026.14709
SARS-CoV-2 as a cause of fatal intestinal perforation
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 25 May 2026
Gastrointestinal (GI) perforation in association with COVID-19 is uncommonly reported in the literature. In this study, our goal was to elucidate the possible pathologic role of SARS-CoV-2 on the GI tract in a patient suffering from intestinal perforation. A literature review using PubMed identified 40 additional cases of COVID-19-related GI perforation. Including our case, a total of 41 cases has been described in the literature, 18 of which were fatal. Including our case, in only three cases SARS-CoV-2 RNA was detected in intestinal surgical specimens. The detection of Sars-Cov-2 viral RNA in GI tissue samples has not been adequately standardized, and consistent results are lacking. Regular testing for SARS-CoV-2 in biopsy and surgical specimens would be necessary to establish its true, direct pathological role in the GI manifestations associated with COVID-19, also in those patients with severe illness or on treatments like glucocorticoids and tocilizumab.
Downloads
1. Spirina LV, Masunov VN, Dyakov DA, et al. Sars-Cov2 induced biochemical mechanisms in liver damage and intestinal lesions. Indian J Clin Biochem 2022;38:1-10. DOI: https://doi.org/10.21203/rs.3.rs-1331115/v1
2. Fang LG, Zhou Q. Remarkable gastrointestinal and liver manifestations of COVID-19: a clinical and radiologic overview. World J Clin Cases 2021;9:4969-4979. DOI: https://doi.org/10.12998/wjcc.v9.i19.4969
3. Trevelin SC, Pickering S, Todd K, et al. Disrupted Peyer's patch microanatomy in COVID-19 including germinal centre atrophy independent of local virus. Front Immunol 2022;13:838328. DOI: https://doi.org/10.3389/fimmu.2022.838328
4. Cuicchi D, Gabrielli L, Tardio ML, et al. Virological and histological evaluation of intestinal samples in COVID-19 patients. World J Gastroenterol 2022;28:6282-93. DOI: https://doi.org/10.3748/wjg.v28.i44.6282
5. De Nardi P, Parolini DC, Ripa M, et al. Bowel perforation in a Covid-19 patient: case report. Int J Colorectal Dis 2020;35:1797-800. DOI: https://doi.org/10.1007/s00384-020-03627-6
6. Corrêa Neto IJ, Viana KF, da Silva MBS, et al. Perforated acute abdomen in a patient with COVID-19: an atypical manifestation of the disease. J Coloproct 2020;40:269–72. DOI: https://doi.org/10.1016/j.jcol.2020.05.011
7. Almeida Vargas A, Valentí V, Sánchez Justicia C, et al. Severe colon ischemia in patients with severe coronavirus-19 (COVID-19). Rev Esp Enferm Dig 2020;112:784-787. DOI: https://doi.org/10.17235/reed.2020.7329/2020
8. Rojo M, Cano-Valderrama O, Picazo S, et al. Gastrointestinal perforation after treatment with tocilizumab: an unexpected consequence of COVID-19 pandemic. Am Surg 2020;86:565-566. DOI: https://doi.org/10.1177/0003134820926481
9. Nahas SC, Meira-JÚnior JD, Sobrado LF, et al. Intestinal perforation caused by COVID-19. Arq Bras Cir Dig 2020;33:e1515. DOI: https://doi.org/10.1590/0102-672020190001e1515
10. Persiano T, Grulli F, Cornara P, et al. Necrotising vasculitis in Covid-19: watch out for bowel perforation. Res Square 2020. doi: 10.21203/rs.3.rs-79258/v1. DOI: https://doi.org/10.21203/rs.3.rs-79258/v1
11. Giuffrè M, Bozzato AM, Di Bella S, et al. Spontaneous rectal perforation in a patient with SARS-CoV-2 infection. J Pers Med 2020;10:157. DOI: https://doi.org/10.3390/jpm10040157
12. Verma, D, Sharma S, Garg LK, Tinaikar A. Gastrointestinal perforation in COVID-19 patients–case series and review of the literature. Clin Surg Res Comm 2020;4:13-17. DOI: https://doi.org/10.31491/CSRC.2020.12.064
13. Bulte JP, Postma N, Beukema M, et al. COVID 19 and the risk of gastro-intestinal perforation: a case series and literature review. J Crit Care 2022;67:100-103. DOI: https://doi.org/10.1016/j.jcrc.2021.10.020
14. Estevez-Cerda SC, Saldaña-Rodríguez JA, Alam-Gidi AG, et al. Severe bowel complications in SARS-CoV-2 patients receiving protocolized care. Rev Gastroenterol Mex (Engl Ed) 2021;86:378-86. DOI: https://doi.org/10.1016/j.rgmxen.2021.08.009
15. Jeffrey J, Anto D, Musthafa S, et al. Colonic perforation in critically ill COVID-19 patients: a case series highlighting surgical management and outcomes. Cureus 2024;16:e70839.
Ethics Approval
CRediT authorship contribution
Antonio Mastroianni, conceptualization, writing – original draft preparation, review and editing; Roberto Manfredi, supervision, review and editing; Valeria Vangeli, data curation, formal analysis, methodology; Giuliana Guadagnino, Luciana Chidichimo, Lavinia Berardelli, data curation, formal analysis; Sonia Greco, writing – original draft preparation, review and editing. All authors have read and agreed to the published version of the manuscript.
Supporting Agencies
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
