Pneumoperitoneum and COVID-19. A causal association?

We read with great interest the letter from Pérez Naranjo et al. regarding the case we recently published in this journal. We believe that the case presented by the authors is undoubtedly useful as it contributes to the scarce existing casuistry on the relationship between COVID-19 and the development of pneumatosis/pneumoperitoneum. We would like to emphasize the difficulty of determining the causality of this association due to the frequent co-occurrence of other causes that could justify the presence of pneumatosis/pneumoperitoneum.