COVID-19 in the peritoneal fluid: does this evidence oblige to introduce new rules? Presentation of a Case Report

Abstract

Background : The Covid 19 pandemic introduced the need to outline new guidelines for the treatment of the Covid positive patient in surgery. With this report we present what we believe to be important additional information about an area that has not yet been studied, the potential infectivity of peritoneal secretions.Case presentation : A 73-year-old woman accesses our PS where she is found to be positive on the nosepharyngeal swab for Covid 19. The patient presents a picture of intestinal occlusion from imprisoned hernia, which is why she undergoes exploratory laparotomy surgery. During surgery a peritoneal swab is performed which is positive for Covid 19.Conclusion : This case suggests that, in the presence of patients susceptible to surgical therapy with negative Covid swab, performing a peritoneal swab may reveal a false negative. An extensive database that collects the results of pharyngeal and peritoneal swabs of patients undergoing surgery is necessary to delineate the appropriate approach to the patient in the Covid era.

SARS-CoV-2 in peritoneal swabs from asymptomatic patients undergoing emergency abdominal surgery

“…Additional supporting findings are reported by Rimini et al . [ 11 ] as they describe a case of incarcerated hernia who underwent exploratory laparotomy, in whom the virus was detected in the peritoneal swab. Likewise, Culver et al .…”

SARS-CoV-2 peritoneal positivity and emergency surgery: is there any putative predisposing factor?

“…Similarly, Barberis et al [8], in a 71-year-old woman who underwent subtotal intra-abdominal colectomy for severe colitis, confirmed the virionic presence in the peritoneal swab. Rimini et al [9] showed an amplified RT-PCR positivity in one case of exploratory laparotomy and small bowel resection due to an incarcerated umbilical hernia with concomitant loop necrosis. On the other hand, both Negasering et al [10] and Vudayagiri et al [11] did not find any intraperitoneal molecular positivity approaching cases of laparoscopic appendectomies in COVID-19 patients.…”

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in peritoneal fluid of coronavirus disease 2019 (COVID-19) patients—Prevalence and significance

“…J o u r n a l P r e -p r o o fSurgery carries a high risk of morbidity and mortality, and only emergency procedures should be performed during acute COVID-19 infections. Consequently, patients amenable to analysis of intraperitoneal SARS-CoV-2 presence are rare.Intraperitoneal viral RNA detection was reported in four COVID-19 patients only.Intraperitoneal swab testing3,4 , intraoperative fluid sampling5 and PD effluent 6 enabled SARS-CoV-2 RNA detection by RT-PCR. The PD effluent remained SARS-CoV-2 positive, associated with peritoneal membrane malfunction (PD failure) 6 .…”

“…Intraperitoneal viral RNA detection was reported in four COVID-19 patients only. Intraperitoneal swab testing 3 , 4 , intraoperative fluid sampling 5 and PD effluent 6 enabled SARS-CoV-2 RNA detection by RT-PCR. The PD effluent remained SARS-CoV-2 positive, associated with peritoneal membrane malfunction (PD failure) 6 .…”