ABSTRACT
A 79-year-old female patient presented to the emergency unit with cough and severe shortness of breath. Due to a bilateral multilobular ground glass density result from thoracic tomography, the patient was admitted to intensive care with the preliminary diagnosis of corona virus-2019 (COVID-19), and a continuous positive airway pressure was applied. A polymerase chain reaction (PCR) test was performed, and treatment with hydroxychloroquine and azithromycin was initiated. At the same time, the patient with an arterial blood pressure of 190/100 mm/hg was administered with diuretic treatment to reduce lung congestion. The follow-up computed tomography of the patient showed rapid recovery, and ground glass appearances had completely resolved. The PCR was negative and the patient was diagnosed with acute lung edema. The treatment was prescribed, and the patient was discharged from the hospital. Thoracic tomography findings are useful in early period for COVID-19 diagnosis;however, it may show similar results as other diseases that cause respiratory failure and lead to misleading interpretations.
ABSTRACT
PURPOSE: The COVID-19 pandemic has reformed global healthcare delivery. On 25 March 2020, Intercollegiate guidelines were published in the UK to promote safe surgical provision during the COVID-19 outbreak advocating non-operative management or avoidance of laparoscopy when surgery is essential. The effects of this on the investigation and management of appendicitis remain unknown. METHODS: We performed a multicentre, prospective, observational study from the start of the new guidelines to the 6th of May 2020. We included all patients referred to surgical teams with suspected appendicitis. A recent historical cohort was identified for comparison. The primary outcome was the impact of the COVID-19 pandemic on the use of non-operative management in appendicitis. Secondary outcomes included imaging, negative appendicectomy rate (NAR), length of stay (LOS) and 30-day complications. RESULTS: A total of 63/164 (38%) patients compared to 79/191 (41%) were diagnosed with appendicitis before and after the guidelines were introduced (p = 0.589). CT scanning increased (71/164 vs 105/191; p = 0.033) while ultrasound scanning decreased (71/164 vs 62/191; p = 0.037). Appendicitis was more likely to be managed non-operatively (11/63 vs 51/79; p < 0.001) and, of those managed surgically, with an open approach (3/52 vs 26/28 p < 0.001). The NAR also reduced (5/52 vs 0/28; p = 0.157). LOS was shorter in non-operatively managed patients (1 day vs 3 days; p < 0.001) without a difference in complications (10/51 vs 4/28; p = 0.760). CONCLUSION: Introduction of the guidelines was associated with changes in practice. Despite these changes, short-term complications did not increase and LOS decreased. Questions remain on the longer-term complication rates in non-operatively managed patients.