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Case Reports
. 2025 Jul 10;25(1):545.
doi: 10.1186/s12887-025-05908-x.

COVID-19-associated multiple colonic perforations in a 6-month-old infant: a rare case report

Ali Manafi Anari  1 , Ladan Teymoorzadeh  1 , Ramez Nasiri  2 , Sajjad Narimani  3   4
Affiliations
Case Reports

COVID-19-associated multiple colonic perforations in a 6-month-old infant: a rare case report

Ali Manafi Anari et al. BMC Pediatr. .

Abstract

Background: While COVID-19 primarily manifests as a respiratory illness, gastrointestinal complications-including severe colitis and perforation-have been reported, particularly in adults. However, such presentations in infants remain exceedingly rare.

Case presentation: A 6-month-old infant presented with lethargy and poor feeding, initially diagnosed with sepsis. Subsequent testing confirmed COVID-19 positivity. During hospitalization, the patient developed feeding intolerance, vomiting, and abdominal distension. Imaging revealed free intraperitoneal fluid with suspected perforation. Emergency laparotomy revealed perforations in the transverse and descending colon, necessitating total colectomy.

Conclusion: This case provides laboratory and histopathological evidence linking SARS-CoV-2 to intestinal perforation in infants, suggesting that SARS-CoV-2 may contribute to ischemic or inflammatory bowel injury leading to perforation. Early surgical intervention is critical in such scenarios. Further research is needed to establish causality and pathophysiology.

Keywords: COVID-19; Colectomy; Colonic perforation; Infant; Pediatric surgery; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Department of Pediatrics, Ali Asghar Children Hospital, Iran University of Medical Sciences. Consent for publication: Informed consent for publication of clinical details was obtained from the parents of the patient. Competing interests: The authors declare no competing interests.

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