Management of non traumatic surgical emergencies during the COVID-19 pandemia

Abstract

In December 2019, in Wuhan, China, the first cases of what would be known as COVID-19, a disease caused by an RNA virus called SARS-CoV-2, were described. Its spread was rapid and wide, leading the World Health Organization to declare a pandemic in March 2020. The disease has distinct clinical presentations, from asymptomatic to critical cases, with high lethality. Parallel to this, patients with non-traumatic surgical emergencies, such as acute appendicitis and cholecystitis, continue to be treated at the emergency services. In this regard, there were several doubts on how to approach these cases, among them: how to quickly identify the patient with COVID-19, what is the impact of the abdominal surgical disease and its treatment on the evolution of patients with COVID-19, in addition to the discussion about the role of the non-operative treatment for abdominal disease under these circumstances. In this review, we discuss these problems based on the available evidence.

The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review

“…The initial search produced 135 potentially relevant articles. After 85 articles were screened for relevance of titles and abstracts, 50 full text articles were further assessed for eligibility and 25 were excluded ( Supplementary Table S1 ); thus, 25 trials were included in the review [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Their characteristics are reported in Table 1 , Table 2 , Table 3 and Table 4 .…”

“…Very few studies investigated patients with COVID-related pneumonia in this setting. Traditionally, the factors in favor of non-operative treatment are Hinchey I and II diverticulitis, whereas failure of this approach favors operative treatment [ 35 ]. Costanzi et al described a case of acute perforated diverticulitis (mesenteric free fluid-gas collection of 20 × 25 mm diameter and free intraperitoneal air) initially undergoing medical treatment and postponing surgery; however, the patient underwent emergency surgery for increased parasigmoid collection (up to 10 cm diameter).…”

Acute Diverticulitis in Covid-19 Patients: Parallel Management in Three Cases. Are the Guidelines Adapting?

“…A Brazilian work by Parreira J. G. et al showed indications about non-operative treatment in non-traumatic emergencies. In the pandemic context, if the operation can be postponed without increasing the risk for the patient, it seems to be the best option 17 . Surgical treatment was probably indicated also in our case 3, but the general conditions of the patient and the adequate control of the abdominal infectious condition made us decide on a less invasive procedure.…”

Apendicite Aguda e suas Complicações Desencadeadas pela Pandemia COVID-19 / Acute Apendicitis and its Complications Unleashed by Pandemia COVID-19

“…Vale salientar que o referido estudo pode ser extrapolado à todas as urgências cirúrgicas abdominais não traumáticas, como hérnias encarceradas ou colecistite aguda calculosa (PARREIRA et al, 2020), visto que possuem elevado potencial de complicações e de óbitos, necessitando de uma rápida tomada de decisão para um salutar desfecho ao paciente.…”