RESUMO
A 60-year-old male patient with a prior coronavirus disease 2019 (COVID-19) pneumonia diagnosis presented with a right foot ulcer. The ulcer progressed to osteomyelitis of his right fifth metatarsal with eventual amputation and resection of the affected digit. The infection recurred two months later and spread to the right fourth metatarsal and gangrene, leading to the amputation and partial metatarsal head resection of the fourth toe. A month later, the infection recurred for a second time and a decision to perform a right trans metatarsal amputation of the foot was evaluated to avoid further progression of the infection and the need for more invasive surgical intervention.
RESUMO
Pneumatosis intestinalis (PI), pneumoperitoneum, and ascites are radiographic findings that may be incidental or associated with severe bowel compromise. Asymptomatic patients with benign PI, pneumoperitoneum, or ascites are often observed or treated conservatively. However, these findings are concerning in symptomatic patients and often require surgical consultation and urgent surgical intervention Approximately 15% of PI cases are idiopathic, and 85% are secondary due to an underlying pathology including but not limited to pulmonary disease, autoimmune disease, drug-induced sources, gastrointestinal disease, infectious sources, and iatrogenic sources. A management plan for PI proves challenging to create when the pathogenesis is poorly understood and the presenting clinical picture varies. Reported is a case of a 51-year-old female with severe abdominal pain, PI, pneumoperitoneum, and ascites. Managing a patient presenting this way with surgical intervention is a viable option; however, this patient's management was successful using a conservative approach.
