S3174 Acute Gastroparesis and Colonic Dysmotility in the Setting of COVID-19

Introduction: Gastric manifestations of SARS-CoV-2 infection are not uncommon and may even precede respiratory symptoms. Common gastrointestinal symptoms include loss of appetite, diarrhea, nausea, vomiting and abdominal pain. Here, we describe a case of a 74 year old-old male with acute COVID-19 infection with acute gastroparesis and hypomotility in the large intestine, which to our knowledge has not been previously described. Case Description/Methods: A 74 year-old male with a past medical history of Dementia, Parkinson's Disease, Controlled Type 2 Diabetes Mellitus was admitted with worsening dyspnea found to be COVID-19 positive. Vitals on presentation: 84 beats/min heart rate, 151/95 mmHg blood arterial pressure, 98.1 F temperature, 18 breaths/min, and 89% O2 saturation. On examination, he was oriented to person, place, but not time. Breath sounds were coarse bilaterally, and the abdomen was soft, mildly distended, active bowel sounds. Initial lab work was unremarkable. He was admitted and started on dexamethasone, remdesevir, and supplemental oxygen via nasal cannula. The following day, the patient had increasing abdominal distention and nausea. An abdominal film was obtained which revealed a gas-distended stomach with concern for gastric outlet obstruction. CT showed similar gastric distention, progression of oral contrast, and dilated sigmoid colon. The patient was made NPO and nasogastric (NG) tube was placed with removal of 1L of bilious content, a bedside rectal tube was placed, and IV metoclopramide was started. Over the next several days, the patient had a gradual improvement in NG output and abdominal distention with close monitoring. Follow up abdominal plain films showed complete resolution of gastric and colonic distention, tubes were removed, and diet was advanced. Diet was advanced and oxygen was weaned off, and he was discharged in stable condition. Discussion: Our case describes an uncommon manifestation of acute gastroparesis and colonic dysmotility in the setting of acute COVID-19 as opposed to the classic diarrhea, nausea, abdominal pain. It remains unclear whether his symptoms were a direct result of the COVID-19 infection or a manifestation of his acute illness or undiagnosed condition. Nevertheless, bringing awareness to this transient manifestations of COVID-19 is clinically relevant and highlights our management strategy. Our patient improved gradually with supportive care including gastric and colonic decompression, electrolyte optimization, bowel rest, and time..