ABSTRACT
Aim: COVID-19 is mostly well known because of its respiratory pathology, nevertheless several ischemic complications have been reported during the pandemia. The aim of this report is to present 9 cases of acute intestinal ischemia in patients with concomitant SARS-COV- 2 bilateral pneumonia. Method(s): We present a case series collected from a retrospective database, that includes 9 patients with intestinal ischemia and bilateral COVID 19 pneumonia diagnosed during the years 2020 and 2022 at the "Hospital Universitario Nuestra Senora de Candelaria." Results: Of the 9 patients, 6 were men with a mean age of 63 years, 5 of them unvaccinated and 2 with partial dose. All presented with bilateral covid pneumonia requiring admission and intubation at the intensive care unit. During admission, after a hemodynamic worsening with increasing lactate, acute intestinal ischemia was diagnosed on a CT scan (7 non occlusive and 2 occlusive ischemia of the SMA). 7 of them underwent damage control surgery of whom only 2 survived. The remaining 3, died hours after diagnosis, not undergoing surgical treatment due to poor short-term prognosis. Conclusion(s): The severe inflammatory response along with a hypercoagulable state secondary to COVID 19 is responsible for many severe ischemic diseases such as intestinal ischemia. These can go unnoticed in intubated critically ill patients, or with concomitant respiratory disease due to the absence of obvious clinical manifestations. Given its high mortality, it is essential to take this differential diagnosis into account, to obtain an early diagnosis and treatment.
ABSTRACT
Aim: The COVID-19 pandemic has drastically impacted the surgical world. Proctology has been severely affected by the reorganisation of healthcare systems over the last year. We present the COVID-19 infection screening protocol that we have carried out in our Major Ambulatory Surgery (MAS) unit for proctological procedures. Method(s): Analysis of the cases operated between April-20 and February-21 in the MAS unit following the protocol established for screening against COVID-19 for both, patients and staff, system alerts and solutions to outbreaks. Screening of patients is carried out by PCR test 48h prior to the intervention, outside the unit and extracted by trained staff. If positive, the intervention is postponed for 40-60 days or until a negative PCR is obtained. Screening of all staff is carried out weekly with a PCR test and 24-48 hours before any professional enters in the unit. If a positive case is detected, it is isolated for a week until negative PCR is obtained and all contagions are tested on days 0, 4 and 8. If an outbreak of less than 3 professionals is detected, they are isolated and follow-up continues. In case of 4 or more, activity in the unit is stopped until PCR is negative. Result(s): 2068 procedures were performed in the MAS unit of which 202 were proctological interventions: 38.6% perianal fistulas, 20.8% haemorrhoids, 12.9% anal dysplasia, 9.4% fissures and 18.32% other pathologies. 48 positive cases of patients were detected and the intervention was postponed without prejudice to the patients. Five alerts were detected in the staff screening, with a maximum of 3 professionals infected in one outbreak. The affected cases were removed from the unit until a negative PCR test was obtained. At no time did the MAS unit have to be closed due to infection. Conclusion(s): Our COVID-19 screening for patients and professionals has been effective and has allowed us to continue our healthcare practice during the pandemic, without the need to close the unit due to outbreaks.