A 59-year-old man presented to our hospital with a 10-day history of fever, progressive dyspnoea, and a confirmed diagnosis of bilateral COVID-19 interstitial pneumonia. His past medical history was unremarkable, except for mild hypertension. On day 5 after admission, he complained of worsening acute abdominal pain with nausea associated with grade 3 arterial hypertension (160/115 mmHg). Blood tests showed a 30-fold increase of D-dimer levels with leucocytosis and lymphopenia.

A contrast-enhanced computed tomography scan of the chest and abdomen revealed the classic features of COVID-19 pneumonia as well as air fluid levels in the small bowel with associated mesenteric edema and peritoneal free fluid (Figs. 1, 2a–c). The patient had an emergency laparotomy with evidence of segmental small bowel ischemia (Fig. 3a, b). A 15-cm small bowel resection and side-to-side manual anastomosis were performed. The peritoneal fluid, analysed for COVID-19 by reverse transcription-polymerase chain reaction, was negative. The patient died of multiorgan failure on the 4th postoperative day.

Fig. 1
figure 1

Chest CT scan: a view of the typical ground-glass aspect with pulmonary consolidations

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Fig. 2
figure 2

a–c Axial CT images showing air-fluid levels in the small bowel with associated mesenteric oedema and peritoneal free fluid

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Fig. 3
figure 3

a The “Aerosol Box” used during endotracheal intubation. b Small bowel ischemia

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COVID-19 may produce cardiovascular, neurological and ischaemic complications [1, 2]. Currently, the underlying mechanism is poorly understood. Hypercoagulability and endotheliitis may be involved [3]. Patients having surgery have a high mortality rate even during the incubation period [4, 5]. Full protective personal equipment and tailored solutions are mandatory to reduce the risk of transmission [6].