• Joris Paul Bulte, Nynke Postma, Menno Beukema, Bas Inberg, Abe Gerrit Stegeman, and Hans van der Hoeven.
• Queen Beatrix Regional Hospital: Streekziekenhuis Koningin Beatrix, General Surgery, the Netherlands. Electronic address: jorisbulte@gmail.com.
• J Crit Care. 2022 Feb 1; 67: 100103100-103.

BackgroundCOVID19 is a viral disease with pneumonia as its most common presentation. Many presentations and complications have been reported, but gastro-intestinal perforation has not received much attention.Methodsthree cases from our hospital are presented, and the current literature was reviewed.Results, CasesAll three patients were admitted to the ICU with respiratory failure due to COVID19 pneumonia and intubated. Our first patient was treated with steroids, and subsequently diagnosed with rectal perforation on day 34 of his hospital admission. The second patient was treated with steroids and tocilizumab, and diagnosed with colonic perforation 1 day after neostigmine administration, on day 14 of his hospital admission. Our third patient was treated with steroids and tocilizumab, and diagnosed colonic perforation 4 days after neostigmine administration, on day 14 of his hospital admission.Results, Literature25 more cases were found in current literature, both upper GI and lower GI perforations, either as a presenting symptom or during the course of hospitalization. These were often associated with treatment with steroids, interleukin 6 inhibitors, or both.ConclusionsGastro-intestinal perforation is a rare but dangerous complication of COVID19. Treatment with tocilizumab and steroids may both increase the risk of this complication, and hamper diagnosis.Copyright © 2021 Elsevier Inc. All rights reserved.

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