ABSTRACT
The spread of SARS-CoV-2 in Italy has been rapid, with over 230.000 infections and 33.000 deaths (May 31st, 2020). The full impact of COVID19 on surgery is still unknown, as its effects on healthcare strategy, hospital infrastructure, staff, regional economy and colorectal disease progression, may not be evident before several months. No systematic reports are available about a higher incidence of COVID19 infections in patients with cancer. However, available data indicate that older people are more vulnerable, particularly when there are underlying health conditions such as chemotherapy or active cancer. Herein, we present the case of a patient with rectal cancer treated with pull-through technique low anterior rectal resection and coloanal anastomosis with protective loop ileostomy, complicated with Sars-CoV-2 infection and late (31st post-operative day) colic ischemia with colo-vaginal fistula. Late intestinal ischemia is a rare complication and can be secondary to several traditional factors, but certainly small vessel thrombosis related to Coronavirus disease must be taken into consideration.
Subject(s)
Colon/pathology , Coronavirus Infections/complications , Ischemia/surgery , Pneumonia, Viral/complications , Vaginal Fistula/surgery , Aged , Betacoronavirus , COVID-19 , Colon/surgery , Female , Humans , Ischemia/complications , Italy , Pandemics , SARS-CoV-2 , Treatment Outcome , Vaginal Fistula/complicationsSubject(s)
Coronavirus Infections , Disease Outbreaks , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Italy , SARS-CoV-2Subject(s)
COVID-19/complications , Diverticulitis, Colonic/surgery , Intestinal Perforation/surgery , SARS-CoV-2 , COVID-19/diagnostic imaging , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/diagnostic imaging , Humans , Hypertension/drug therapy , Intestinal Perforation/complications , Intestinal Perforation/diagnostic imaging , Male , Middle Aged , Respiratory Distress Syndrome/etiology , Tomography, X-Ray ComputedABSTRACT
Background: The Covid-19 pandemic in Northern Italy has slowed down the clinical surgical activity. A system of hub and spoke hospitals was set up to take care of oncological patients with the consequent almost complete abolition of the elective surgical activity for non-oncological pathologies. Methods: We retrospectively analyzed the surgical volumes of 4 different non academic general hospitals in Lombardy belonging to 4 different provinces. The quarter March April May 2019 was compared with the same period of 2020. All different procedures were listed. The cost analysis was performed using the DRG system. Results: In the four hospitals involved the surgical procedures reduced from 1903 to 350 with a drop of the 81.6%. Procedures for cancer from 403 to 161 with a drop of 60.1%. Procedures for benign disease from 1310 to 118 with a drop of the 91%. Emergencies from 190 to 71 with a drop of the 62.6%. State refund for the procedures performed from 6.708.023 to 1.678.154 with a drop of 75%. Conclusions: Elective surgery was dramatically impaired by the Covid-19 pandemic. Above all procedures for non oncological and non urgent patients were particularly affected. In view of a possible second wave of the pandemic, the surgical planning must select patients not only on onco logical criteria but rather on clinical ones. An ad hoc hub and spoke hospitals pathway has to be implemented for benign surgical diseases by whoever is facing the Covid pandemic at its spike.