Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

Şerban, Dragoş; Socea, Bogdan; Badiu, Cristinel Dumitru; Tudor, Corneliu; Balasescu, Simona Andreea; Dumitrescu, D.; Trotea, Andra Maria; Spataru, Radu Iulian; Vancea, G; Dascălu, Ana Maria; Tănăsescu, Ciprian

doi:10.3892/etm.2021.9950

Cited by 23 publications

(21 citation statements)

References 45 publications

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“…Severe inflammation in the intestine can cause damage to the submucosal vessels, resulting in hypercoagulability in the intestine. Cases of acute cholecystitis, splenic infarction, or acute pancreatitis have also been reported in patients infected with SARS-CoV-2, with microvascular lesions as a pathophysiological mechanism [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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“…The arguments supporting this type of intervention were presented to the parents and in all cases the decision to operate was supported by parental consent (except for one emergency operation for pneumoperitoneum). For the cases admitted during the COVID-19 pandemic, strict regulations to prevent in-hospital dissemination of Sars-cov-2 infection were observed consisting of RT-PCR testing at admission, mask wearing by hospital personnel, and frequent disinfection of the surfaces ( 7 ).…”

Section: Methodsmentioning

confidence: 99%

Neonatal intensive care unit on‑site surgery for congenital diaphragmatic hernia

et al. 2022

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The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of ‘Maria S. Curie’ Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.

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“…Što se tiče komplikacija samih hirurških procedura, u jednoj studiji rumunskih autora, poređeni su pacijenti operisani za vreme KOVID-19 infekcije, od aprila do jula 2020. godine, i pacijenti operisani 2019. godine, u toku istog perioda. Dobijen je zanimljiv podatak -infekcije rane su bile zastupljene u 2% kod operisanih za vreme KOVID-19 pandemije, naspram 13,95% u toku istog perioda 2019 godine [11]. U našoj studiji je 2% pacijenata operisanih od strane opštih hirurga razvilo kliničku sliku infekcije operativne rane, s tim što su svi operisani imali potvrđenu KOVID-19 infekciju.…”

Section: Discussionunclassified

The role of surgeons during the COVID-19 pandemic: The experience of the Surgery Clinic of the Clinical Hospital Center 'Zemun'

Stojanović¹,

Mitrović²,

Stevanović³

et al. 2021

Srpski medicinski časopis Lekarske komore

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Introduction: In December 2019, the existence of a new type of disease, caused by SARS coronavirus 2 (SARS-CoV-2), was discovered in the city of Wuhan, the Republic of China. The disease itself is characterized by a large number of patients with moderate and severe clinical presentation, who require hospital treatment. The organization of the healthcare system of Serbia, during the aforementioned pandemic, has required the engagement of all doctors, regardless of their specialty, in the treatment of patients with COVID-19. Surgeons of all branches, from the Surgery Clinic of the Clinical Hospital Center Zemun, were directly engaged in the treatment of both primary manifestations of the virus and the numerous surgical complications arising in the wake of this disease, but also in the treatment of primary acute surgical diseases in COVID-19-positive patients. Aim: The aim of this paper is to present the functioning of the Surgery Clinic of CHC Zemun, in the conditions of the COVID-19 pandemic, as well as to present the types and results of surgical procedures performed in patients with the COVID-19 infection. Methods: This study was conceived as a retrospective study and was conducted in the period between February 2020 and April 2021, in patients who had undergone emergency surgery and in whom the COVID-19 infection had previously been verified. A total of 232 patients surgically treated at the level of the entire Surgery Clinic of the CHC Zemun participated in the study. Results: Chest drainage, due to the development of pneumothorax, accounted for a quarter of all surgical procedures performed, while, in 53.85% of cases, surgical treatment was undertaken due to acute abdomen of various etiology, and in 21.15% of cases, due to vascular diseases. Conclusion: The COVID-19 pandemic is, in itself, a major challenge for the entire healthcare system. The role of the surgeon is significant, both in organization and in direct treatment, which is additionally complicated by the uniqueness of the entire situation and the severity of the disease itself. In addition to their involvement in the treatment of the COVID-19 infection itself, surgeons were, in a large number of cases, engaged in their primary activity in health care, i.e., in the treatment of surgical diseases and complications of COVID-19, performing demanding surgical procedures in very difficult and unique conditions.

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Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

Cited by 23 publications

References 45 publications

Acute Mesenteric Ischemia in COVID-19 Patients

Acute Mesenteric Ischemia in COVID-19 Patients

Neonatal intensive care unit on‑site surgery for congenital diaphragmatic hernia

The role of surgeons during the COVID-19 pandemic: The experience of the Surgery Clinic of the Clinical Hospital Center 'Zemun'

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