COVID‐19 collateral damage: delayed presentation of a perforated rectal cancer presenting as Fournier's gangrene

Abstract

of delayed paediatric emergency presentations in which the parents of all cases reported avoiding the hospital due to fears of contracting COVID-19. Half of the children were admitted to intensive care unit and four died. 2 New York has experienced a significant decline in acute coronary syndrome presentations. 3 Similarly, delays in referral to surgical teams result from awaiting COVID-19 clearance as testing is performed on patients presenting with gastrointestinal symptoms as these symptoms have been associated with COVID-19 infection. 4,5 Similar effects were seen during the severe acute respiratory syndrome (SARS) outbreak at the beginning of the millennium. At the peak of the SARS epidemic, Taiwan saw a significant reduction in ambulatory care, inpatient care and dental care patients. 6 Fear of contracting SARS influenced people's willingness and choice to seek adequate medical care. 6 These concerns were reflected in cancer patients at the Taipei Veterans General Hospital, Taiwan, as 63.8% were afraid of visiting hospital during the SARS infective period and 36.2% felt SARS was more severe and fatal than their underlying cancer. 7 Locally, the impact of COVID-19 has led to significant changes in surgical practice. Non-emergency surgeries (category 2within 90 days and category 3within 365 days) have been suspended, protocols regarding intubation and extubation have been developed and the risk of viral exposure from surgical smoke in laparoscopic surgeries continues to be an issue of growing debate. 8 Acute surgical pathologies, such as appendicitis, usually treated by surgical intervention have been reconsidered towards medical management. 8 The COVID-19 pandemic has drastically changed medical practice worldwide and as focus remains on control of the virus, there are concerns over the toll on non-COVID patients. 3 Fear of contracting the virus will undoubtedly impact non-COVID patients seeking adequate and timely medical care. As face-to-face consults are exchanged for alternate reviews, such as teleconferencing, healthcare workers must consider its implication on adequate clinical assessment. The challenge lies in continuing to deliver optimum care to patients, when patients themselves are too scared to seek assistance in fear of contracting, what they perceive as a more serious illness. From the surgeons' perspective, bacterial sepsis left unchecked will result in death or require intensive care support, in a higher proportion than what has currently been seen with COVID-19 within Australasia. This message needs to reach the community, such that late presentations as described within this article are avoided.

Traumatic jejunal perforation associated with SARS-CoV-2 (COVID-19) infection

“…[7][8][9][10][11] However, most authors suspect that angiotensinconverting enzyme 2 (ACE-2), the primary cellular receptor for SARS-CoV-2, is involved since ACE-2 is highly expressed in the intestinal tract. [1][2][3][4][5][6][7][8]12,13 Consistent with this patient, several reports have documented neutrophilia and increased lymphocytes in COVID-19 patients. [14][15][16][17] Furthermore, autopsies of COVID-19 patients show neutrophil infiltration in pulmonary capillaries and alveolar spaces.…”

“…The possibility that COVID-19 infection causes or contributes to development of gastrointestinal perforations has been raised by several case reports affecting all age groups. [2][3][4][5][6][7][8][9] The most common causes proposed for COVID-19 gastric perforations include high-dose steroids, tocilizumab (an interleukin-6 inhibitor), stress-related mucosal damage, and small vessel thrombosis and nonocclusive mesenteric ischemia. [7][8][9][10][11] However, most authors suspect that angiotensinconverting enzyme 2 (ACE-2), the primary cellular receptor for SARS-CoV-2, is involved since ACE-2 is highly expressed in the intestinal tract.…”

“…1 However, several case reports have suggested a potential role of COVID-19 in causing gastrointestinal perforations. [2][3][4][5][6][7][8][9] We report a case of a gastrointestinal perforation in a COVID-19 patient developing after a motor vehicle accident.…”

The impact and collateral damage of COVID-19 on prostate MRI and guided biopsy operations: Society of Abdominal Radiology Prostate Cancer Disease-Focused Panel survey analysis

“…While COVID-19 directly affects the patients, families, and healthcare workers, it indirectly causes disruptions and delays in health care in multiple settings. There are case reports describing the delays in medical care and cancer diagnosis [3,4]. The healthcare system changes have also threatened the delivery of trauma and acute stroke care due to the diversion of resources [5,6].…”

Comparison of Perforated Appendicitis Prior to and Post quarantine during COVID19 Pandemic

“…The idea of possibly delaying care secondary to patient fear has sparked investigation into surgical emergencies as well. Patel et al has speculated that there may be an association between COVID-19 infection and perforated diverticulitis [8], while Karam et al describes a case of perforated rectal cancer as a result of delayed presentation during this time period [9]. Of the studies that have been published related to appendicitis during the pandemic, there has not been an increased incidence of perforated appendicitis reported.…”