ABSTRACT
Disconnected pancreatic duct syndrome (DPDS) is a rare but important complication of acute necrotizing pancreatitis (ANP). This syndrome presents as a circumferential discontinuity of the ductal anatomy between the pancreatic secreting tissue and the gastrointestinal tract. Most cases do not respond to conservative therapy and require surgical intervention. This condition is a challenge for the medical team, given the delay in diagnostic suspicion and the need for multimodal therapeutical approach. Acute pancreatitis has been reported in patients with COVID-19, although a direct cause and effect relationship has not yet been established. Whether infection with new Coronavirus can contribute as worsen-ing factor in acute pancreatitis due to viral tropism to pancreatic cells is not known. We present the case of a 44-year-old male patient with a diagnosis of acute necrotizing pancreatitis who evolved with disconnected duct syndrome due to necrosis of the central region of the pancreas. He performed multiple drainages of the collections and necrosectomy, with persistent pancreatic fistula, eventually requiring caudal pancreatec-tomy. This patient had a diagnosis of COVID-19 and thromboembolic events during hospitalization, constituting a challenge for treatment. He presented a good postoperative clinical evolution, being discharged 5 months after admission. Disconnect duct syndrome frequently presents as a treatment challenge. These patients are severe and an overlapping COVID infection acts as an important aggravating factor. Whether the infection is related to pancreatitis, either in its genesis or acting as a worsening factor has not yet been established.(Cite this article as: Capaverde LH, Hinrichsen LB, Fetzner B, Pieta MP, Cardoso AM, Costa LB, et al. Acute necrotizing pancreatitis and discon-nected pancreatic duct syndrome associated with COVID-19. Chirurgia 2022;35:241-5. DOI: 10.23736/S0394-9508.21.05347-X)
ABSTRACT
Introduction: Due to restrictions caused by the COVID-19 pandemic, elective procedures were canceled or postponed. This study aims to compare the epidemiological profile of cases from Brazilian’s Public Healthcare System (SUS) and Private Healthcare (PH) in a teaching single-center facility between 2019 and 2021. Methods: Data were gathered from patients who underwent lung resection (LR) by PUCRS’s Sao Lucas Hospital Thoracic Surgery team between 2019 and 2021. Data were obtained by retrospective review of electronic charts in March 2022. A retrospective analysis was made. Results: There were 212 procedures performed, being 80 in 2019, 66 in 2020 and 66 in 2021. In 2019, there were 45 (56.2%), in 2020, 43 (65.1%), and in 2021, 34 (51,5%) LR on SUS. Lobectomies on SUS in 2019 were 19 (42.2%), in 2020, 13 (30.2%), and in 2021, 17;on PH were 19 (54.2%) in 2019, 12 (52.1%) in 2020, and 18 in 2021. On SUS, in 2019 were performed 41 (91%) open thoracic surgeries and in 2020, there were 33 (76%);on PH, in 2019 video-assisted thoracic surgery (VATS) was done in 24 (68.5%) patients, 17 (73.9%) in 2020 and 29 (75%) in 2021. Procedures for oncological disease (primary or metastatic) on SUS in 2019 were performed in 27 (60%) patients, 23 (53.4%) in 2020, and 13 (44,8%) in 2021;on PH, in 2019, there were 23 (65.5%) patients, in 2020 were 15 (65.2%), and 16 (55,2%) in 2021. On SUS there were 24 women in 2019 (53%) and in 2020 (55%);on PH, there were 23 (65%) men in 2019 and 13 (56%) in 2020. The mean age of patients on SUS was 59, and 66 on PH. Clinical staging (CS) for primary lung cancer on SUS in 2019 was 12 (50%) CS I, 8 CS II, 3 CS III, and 1 CS IV;in 2020 was 8 (47%) CS I, 6 CS II, and 3 CS III. On PH, in 2019, there were 12 (66.6%) CS I, 4 CSII, and 2 CS IV;in 2020, 11 (84.6%) CS I and 2 CS II. Conclusions: We found maintenance in the numbers of procedures in 2020 and 2021, but a global reduction in the number of LR on SUS, mainly because the pandemic became worst in its second year, leading to the closure of surgery centers. And a reduction of 17.5% in the number of LR in 2020, compared with 2019. Lobectomies lowered 36.8% on PH and 31.5% on SUS between 2019 and 2020. Albeit there was a reduction in general incidence, LR for oncological reasons predominated. In 2021 it represented 82,8%, with 44,8% on SUS, and 52,2% on PH. There was a higher average age on PH. Open thoracic surgery was most frequent on SUS due to limitations on offered equipment, while VATS predominated on PH (difference: 44.5%). The predominant CS remained equal on both healthcare systems, CS I, which indicates maintenance of early-stage diagnoses. Nevertheless, the overall incidence has diminished (33.33% [SUS] and 8.3% [PH]), a probable reflection of the pandemic. Keywords: COVID-19, Thoracic Surgery, Lung Cancer