Cecal Perforation in a COVID-19 Patient Treated with Tocilizumab: A Case Report

Tocilizumab is a monoclonal antibody against the interleukin-6 receptor. Gastrointestinal perforation has been associated with Tocilizumab treatment. In the absence of specific antiviral drugs, Tocilizumab is currently being used as a treatment option in patients with severe COVID-19 pneumonia. This is being based on the implication of interleukin-6 in the aberrant host immune response that characterizes the disease and initiates patients' lung damage. Herein we present the case of a cecal perforation in a patient treated with Tocilizumab for COVID-19. In such context, we expect that there may be an increase in the incidence of gastrointestinal perforation related to Tocilizumab.

A CASES OF ACUTE COLONIC PSEUDO-OBSTRUCTION LEADING TO CECAL PERFORATION POST LSCS CASE.

Acute colonic pseudo-obstruction is rare but not very un-common to nd post LSCS, if diagnosed late can cause severe maternal morbidity and mortality. Surgical intervention is must if diagnosed late, and is associated with long term morbidity to the patient. In this case, signs of bowel perforation were noted and laparotomy performed, ndings suggestive of cecal perforation were seen. Although uncommon after a Caesarean section but diagnosis of Ogilvie’s syndrome should be kept in mind.

Appendicitis-Like Picture Induced by Foreign Body in a 2-Year-Old Boy

Background and Aim. Appendicitis is unusual in toddlers and foreign body- (FB-) induced appendicitis is rare. We present a FB-induced appendicitis in a toddler with no suggestive history of FB ingestion. Case Presentation. A 2-year-old healthy boy presented to the emergency department with irritability for 3 days duration associated with fever of 39°C, nausea, anorexia, and vomiting. There was no history of foreign body ingestion. The abdomen was distended and diffusely tender. An abdominal ultrasound (US) was suggestive of perforated appendicitis with appendicular mass formation. An abdominal X-ray showed a pin-like foreign body in the abdomen. An emergent appendectomy was performed. Intraoperatively, a sealed small cecal perforation was noticed. A 5 cm pin-like metallic foreign body was found to obstruct the appendicular lumen. The appendix was grossly normal without inflammatory changes. Conclusion. FB-induced perforations or appendicitis albeit in patients with no history of FB ingestion or infants and toddlers need a high clinical suspicion to prevent the delay in diagnosis and the subsequent complications.

Pencil spring ingestion in a neonate- a rare occurrence with cecal perforation: A case report

Background: Foreign body (FB) ingestion is relatively common in the pediatric population. However, it is a rare occurrence in neonates and intestinal perforation due to ingested FB is once in a blue moon event. Case Presentation: Here we present a case of accidental FB ingestion by a neonate leading to a rare complication. The patient was received in vitally unstable condition and exploratory laparotomy was performed after initial resuscitation. The intra-operative findings included perforation of the cecum, which was repaired with a covering stoma. The postoperative period was uneventful, and stoma was reversed later. Conclusion: Foreign body ingestion is possible in neonates, though very rare, and can lead to fatal complications If not detected and treated in time.