ABSTRACT
Introduction: Coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has caused a global health crisis. Initially considered a respiratory tract pathogen, it can cause multiple organ dysfunction. It has also been described to predispose to venous and arterial thromboembolism;however, limited published data is available regarding mesenteric thrombosis COVID-19. Clinicians should be aware of the life-threatening situation in COVID-19 patients. Method(s): A case series analysis of 9 patients admitted and managed under department of operation over a duration of 13 months from September 2020 to September 2021 Results: Out of the total of 9 cases of intestinal ischemia, 3 were COVID-19 positive (rapid antigen, RT PCR or CORADS 4 or higher), overall mortality being 55.5% and patients with COVID- 19 were found to have 100% mortality in the study. Mortality in conservatively managed patients was 100%, Mortality in surgically managed patients was 42.8%. Pre operative acidosis, hypoxia and hypotension were found to be important determinants of outcome of the disease. Conclusion(s): Treatment of COVID - 19 and intestinal Ischemia should go simultaneously and in line with the latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to the COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia. Perioperative acidosis, hypoxia and hypotension are important determinants of the outcome of the course of the disease.
ABSTRACT
Aims: To determine The presentation and outcomes of cases of intestinal Ischemia amidst COVID-19 pandemic and to review latest guidelines in its management. Method(s): A case series analysis of 11 patients admitted and managed under Department of Surgery, over a duration of 17 months from September 2020 to January 2022. Result(s): Out of The total of 11 cases of intestinal ischemia, 4 were COVID-19 positive, overall mortality was 54.5% and patients with COVID-19 were found to have 100% mortality. Mortality in conservatively managed patients was also 100%, Mortality in surgically managed patients was 55.5%. Preoperative acidosis, hypoxia and hypotension were found to be important determinants of outcome of The disease. Conclusion(s): Occurrence of intestinal Ischemia in COVID-19 patients is a life threatening complication which demands Surgical management with significant mortality. Treatment of COVID-19 and intestinal Ischemia should go simultaneously and in line with The latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to The COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia.
ABSTRACT
Background: Primary spontaneous Upper extremity deep vein thrombosis is rare with an estimated annual incidence of 1 to 2 cases per 100,000 population. The majority of cases are secondary and related to central venous cannulation (eg, central line, pacemaker) or prothrombotic states. on The of fset of COVID-19 pandemic such cases could become a common entity. Case Report: An elderly diabetic and hypertensive female patient presented with a history of acute onset swelling, heaviness, tingling and numbness of left Upper limb since 1 week. Examination revealed, diffuse swelling of left Upper limb extending to neck with small dilated veins in left Upper cheSt. A provisional diagnosis of left Upper limb DVT was made based on Constants criteria and was confirmed on Duplex scanning. The patient was started on LMWH for anticoagulation. Evaluation for occult cancers was unremarkable. Patient showed symptomatic improvement and recanalisation of thrombosed veins was noted on repeat duplex scan. Conclusion(s): Upper extremity DVT (UEDVT), once a rare entity, can be seldom thought of, due to widespread interventions and ongoing COVID-19 pandemic. Focus on evaluation of occult malignancy rather for hypercoagulable states which do not change The management. This case report highlights The importance of early recognition of UEDVT and stresses on The evidence that no added benefit is achieved by performing expensive tests to rule out prothrombotic states. Early diagnosis based on Constants criteria and anticoagulation would save time and prevent grave complications.
ABSTRACT
Aim: To determine The efficacy of single layer bowel repair with respect to postoperative complications such as leakage rates, duration of repair, overall length of hospital stay, cost effectiveness, to assess The morbidity, mortality and outcome. Method(s): This prospective study was done on 21 patients admitted under Department of Surgery from The period of January 2020 to September 2021. All The patients under bowel repair in continuous single layer extramucosal fashion for various etiology, follow up data was collected and analysed. Result(s): In our study, 81% (17 cases) of The single layer bowel repair were done in an Emergency setting. The study consisted of 42.9% (9 cases) of perforation repair and 57.1% (12 cases of resection and anastomosis of large or small bowel). The average time duration of anastomosis was 14.45 minutes with The average hospital stay of 13.2 days. Our study showed an anastomotic leak rate of 9.5% (2 cases) with an overall mortality of 19.04% (4 cases) which included 2 cases with COVID-19 related ARDS. Conclusion(s): Our study was determined to analyse The effectiveness of single layer bowel repair and found that it is a quicker and theoretically better technique for bowel repair which avoids unnecessary tissue ischemia. The leakage rates within The study was comparable with other studies published and The studies with double layer bowel repair technique in terms of leak rates and mortality. A meticulously done single layer repair will best double layer repair and Surgical trainees must be trained early to perfect The art of bowel anastomosis.