ABSTRACT
A 63-year-old man was diagnosed with coronavirus infection on day 5 after onset of symptoms and treated at home. On day 6, the patient developed moderate oxygenation failure and was admitted to hospital for initiation of treatment with dexamethasone and remdesivir. On day 9, the condition deteriorated critically and a single dose of tocilizumab was administered. On day 19 post-symptom onset, the patient presented with abdominal pain, and abdominal CT indicated a perforated diverticulum in the sigmoid colon and diffuse peritonitis. In emergency surgery, laparoscopic observation revealed a large amount of pus and severe inflammation of the sigmoid colon. Sigmoid colon resection, colostomy, and intraperitoneal lavage and drainage were performed. On day 28 post-symptom onset, there was acute exacerbation of pneumonia in response to the coronavirus infection during steroid dose reduction. The condition subsequently improved with steroid pulse therapy, and transfer to another hospital was possible at 48 days post-symptom onset. We report this case as an example of perforation of the diverticulum in the sigmoid colon following administration of tocilizumab for treatment of coronavirus infection-associated pneumonia © 2022 The Japanese Society of Gastroenterological Surgery