S2771 Intestinal Obstruction: Unique GI Presentation for COVID-19 in a Young Male Patient!

INTRODUCTION: Fever, cough and shortness of breath have become the classic COVID-19 symptoms But, abdominal symptoms;pain, diarrhea, and vomiting, should alert for possible COVID-19 infection, in addition to respiratory symptoms We are present a case of a young man who presented with intestinal obstruction without respiratory symptoms who tested positive for COVID-19 CASE DESCRIPTION/METHODS: A 30-year-old male presented with abdominal pain, distension, and absolute constipation for two days He had severe epigastric & Right upper quadrant crampy pains associated with nausea and few episodes of vomiting, but denied any diarrhea, fever, chills or shortness of breath He has no known medical history His blood pressure was 120/66 mmHg, pulse was 107 BPM, and body temperature was 37 5°C and the oxygen saturation was 97% on room air Abdomen was diffusely tender with no rebound tenderness or guarding and bowel sounds were noted in all four quadrants Leukocyte count was 8300/mL, CRP was 4 0 mg/dL, and LDH was 166 units/L, while the rest of the hemogram and metabolic panel were within normal range Because of nausea and vomiting, he was tested for COVID-19 RT-PCR testing confirmed COVID-19 infection The chest X-ray was normal, while the abdominal X-ray revealed dilated loops of small bowel suggesting ileus or small bowel obstruction Non-contrast abdominal CT showed Fluid-filled distended stomach and proximal small bowel with Transition to normal caliber small bowels in the right lower quadrant, suggestive of a partial small bowel obstruction without perforation or pneumatosis intestinalis Conservative management with NG tube suction, IV fluid, and pain control was followed by rapid symptom resolution On the second day of admission after a small bowel follow through test showed no obstruction, he tolerated diet and was discharged to home for self-quarantine DISCUSSION: It's important to maintain a level of suspicion of COVID-19 infection in the setting of abdominal symptoms Anorexia, nausea, and diarrhea have been increasingly reported with this novel illness However, it is even more important to not have a false sense of security whenever intestinal obstruction is the presenting symptoms, especially in a young otherwise healthy person Although GI presentation takes the form for anorexia, nausea, and diarrhea in COVID-19 infection, small bowel obstruction can rarely be the only presenting finding for COVID-19 infection