A rare case of COVID-19 related stomach gangrene after an abortion: a case report


  • Komal Gupta Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India http://orcid.org/0000-0003-1162-7629
  • Gopal Puri Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
  • Jnaneshwari Jayaram Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
  • Muhammed Huzaifa Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
  • Kamal Kataria Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India




COVID-19, Coagulopathy, ARDS, CAC, Abortion, Stomach gangrene


A 25 year old female had presented with complaints of severe epigastric pain with abdominal distension and vomiting for 4 days. She had undergone medical termination of pregnancy for a missed abortion of 5 weeks of gestation 5 days prior. The patient's COVID-19 RT PCR was found to be positive. Her CECT showed covid related changes in bilateral lungs and pneumoperitoneum. Stomach was distended. Other small bowels appeared normal. Patient underwent emergency laparotomy. Two third of stomach appeared gangrenous with a perforation in the posterior wall of stomach so she underwent a subtotal gastrectomy. She had features of covid associated coagulopathy (CAC) with high D-dimer (520 ng/ml), thrombocytosis (up to 705,000/mcl), high activated partial thromboplastin time (aPTT) (up to 55.6 sec) and high prothrombin time (PT) (up to 27.9 sec and INR 2.11) for which low molecular heparin was given. Stomach is a highly vascular organ. Gangrene of the stomach has been very rarely reported. CAC is known to lead to both arterial thrombus and venous thromboembolism. COVID-19 related abortions have also been reported though the exact mechanism not certain but CAC could be one of them.


Sanz SP, Arguedas LY, Mostacero TS, Cabrera CT, Sebastián DJJ. Involvement of the digestive system in covid-19. A review. Gastroenterol Hepatol. 2020;43(8):464-471.

Aliberti S, Amati F, Pappalettera M, Di PM, D'Adda A, Mantero M, et al. COVID-19 multidisciplinary high dependency unit: the Milan model. Respir Res. 2020;21(1):260.

Salroo N, Ahangar S. Gastric gangrene "an iatrogenic misadventure". Indian J Surg. 2012;74(6):498-500.

Singh B, Mechineni A, Kaur P, Ajdir N, Maroules M, Shamoon F, et al. Acute intestinaliIschemia in a patient with COVID-19 infection. Korean J Gastroenterol. 2020;76(3):164-6.

Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, et al. Hypercoagulability of COVID-19 patients in intensive care unit: a report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738-42.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.

Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324-9.

Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis. 2020;50(1):54-67.

Marietta M, Coluccio V, Luppi M. COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Intern Emerg Med. 2020;15(8):1375-87.

Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care. 2020;24(1):360.

Kunutsor SK, Laukkanen JA. Cardiovascular complications in COVID-19: A systematic review and meta-analysis. J Infect. 2020;81(2):139-41.

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14.

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-6.

Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York city health system. JAMA. 2020;324(8):799-801.

Szegedi I, Orbán-Kálmándi R, Csiba L, Bagoly Z. Stroke as a potential complication of COVID-19-associated coagulopathy: a narrative and systematic review of the literature. J Clin Med. 2020;9(10):3137.

Uthman I, Khamashta M. The abdominal manifestations of the antiphospholipid syndrome. Rheumatology. 2007;46(11):1641-7.

Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306.

Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet Gynecol. 2020;56(1):15-27.

Xu J, Chu M, Zhong F, Tan X, Tang G, Mai J, et al. Digestive symptoms of COVID-19 and expression of ACE-2 in digestive tract organs. Cell Death Discov. 2020;6:76.

Sanad YM, Jung K, Kashoma I, Zhang X, Kassem II, et al. Insights into potential pathogenesis mechanisms associated with Campylobacter jejuni-induced abortion in ewes. BMC Vet Res. 2014;10:274.

Miech RP. Pathophysiology of mifepristone-induced septic shock due to Clostridium sordellii. Ann Pharmacother. 2005;39(9):1483-8.






Case Reports