Pseudomembranous colitis in patients with COVID-19 (review)

AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications. PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females - 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%. The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy). RESULT(S): the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics - 44.6%, glu-cocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy - 33.08%, laparoscopy - in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confir-mation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients - 78.9%, mortality - 15.0%), colon resection (n = 6 (7.9%), mortality - 66.6%), ileo-or colostomy (n = 8 (10.5%), mortality - 37.5%), colectomy (n = 2 (2.6%), mortality - 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment - 8.8%. CONCLUSION(S): pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelm-ing majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient's condition and the development of severe intra-abdominal complications and sepsis.Copyright © 2022, Association of Coloproctologists of Russia. All rights reserved.

Pseudomembranous colitis in patients with COVID-19 (review).

AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications. PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females - 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%. The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy). RESULT(S): the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics - 44.6%, glu-cocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy - 33.08%, laparoscopy - in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confir-mation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients - 78.9%, mortality - 15.0%), colon resection (n = 6 (7.9%), mortality - 66.6%), ileo-or colostomy (n = 8 (10.5%), mortality - 37.5%), colectomy (n = 2 (2.6%), mortality - 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment - 8.8%. CONCLUSION(S): pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelm-ing majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient's condition and the development of severe intra-abdominal complications and sepsis.Copyright © 2022, Association of Coloproctologists of Russia. All rights reserved.

Pseudomembranous colitis in patients with COVID-19 (review)

AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications. PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females — 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%. The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy). RESULTS: the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics — 44.6%, glu-cocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy — 33.08%, laparoscopy — in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confir-mation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients — 78.9%, mortality — 15.0%), colon resection (n = 6 (7.9%), mortality — 66.6%), ileo-or colostomy (n = 8 (10.5%), mortality — 37.5%), colectomy (n = 2 (2.6%), mortality — 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment — 8.8%. CONCLUSION: pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelm-ing majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient’s condition and the development of severe intra-abdominal complications and sepsis. © 2022, Association of Coloproctologists of Russia. All rights reserved.

Temporary markers of increased risk groups for thrombophlebitis of the saphenous veins of the lower extremities in post-COVID-19 patients

Background: Over the past decades, thrombophlebitis of the saphenous veins (TSV) of the lower extremities has remained one of the most common causes of acute vascular diseases, which requires contact with surgeons. This disease has acquired new risk factors with the advent of a new coronavirus infection. During the time since the onset of infection and up to the present time, many studies have already proven procoagulant effects and endotheliitis, which provoke venous thromboembolic complications. Method(s): We analyzed 379 the outpatient case histories of patients from 2019 to 2021 who applied to a vascular surgeon at polyclinic No. 21 in Ufa and City Clinical Hospital No. 21 with a diagnosis of TSV. Of these, a sample of patients who had a COVID-19 with a polymerase chain reaction confirmed smear, or with signs of viral pneumonia on computed tomography and a COVID-19 was diagnosed. The period from the moment of COVID-19 was limited to 6 months. The number of patients meeting this criterion was: 164 (43.27%). According to the CEAP classification: In 64 (39.02%) C2 stage, in 37 (22.56%)C3, in 8 (4.88%)C4 stage, C6 was in 3 (1.83%) patients, C5 - not a single patient. In 52 (31.71%) patients, there were no signs of previous chronic venous insufficiency. Age of patients: From 48 to 60 years, mean age 56 +/- 4 years. By sex - women - 102 patients (62.19%), men - 62 (37.8%). According to the period from the moment of covid-19 to the onset of thrombophlebitis: In the firstmonth 42 patients, in the period of 2months - 12 patients, in the period of 3 months - 56 patients, in the period of 4 months - 46 patients, in the period of 5 months - 4 patients and after 6 months from COVID-19, TFPV was diagnosed in 2 patients. Result(s): The frequency of episodes of TSV was higher at 1,3,4 months, and the increase prevailed at the end of 3 and the beginning of 4 months. From the anamnesis, in this period of time the intake of anticoagulants prescribed after COVID-19 was completed. In 29 cases, signs of past deep vein thrombosis of the lower extremities were revealed. In 1 case, signs of a past pulmonary embolism, unspecified by prescription, were revealed. Conclusion(s): Episodes of TSV are increased, as after any viral infection, but the role of hypercoagulation syndrome after a COVID-19 is somewhat more important compared to other viral infections. It is worth paying attention to the continuity in relation to the abolition of anticoagulant therapy at the outpatient stage of convalescents of COVID-19..

[Severe pseudomembranous colitis in patients with previous coronavirus infection]. / Psevdomembranoznyi kolit na fone perenesennoi koronavirusnoi infektsii.

OBJECTIVE: To analyze treatment outcomes in patients with severe pseudomembranous colitis and previous coronavirus infection. MATERIAL AND METHODS: We retrospectively analyzed treatment outcomes, clinical, laboratory and histological data in convalescents of COVID-19 who admitted to the department of coloproctology for moderate-to-severe pseudomembranous colitis confirmed by endoscopic examination between 2020 and 2021. RESULTS: There were 13 patients with moderate pseudomembranous colitis and 6 ones with severe pseudomembranous colitis. Mean period after recovery from coronavirus infection was 19 days. Endoscopy revealed whitish-yellow or gray raised plaques on colonic mucosa in all cases. Four patients with signs of peritonitis underwent emergency surgery. Three patients had perforation of caecum; one patient had perforation of sigmoid colon and widespread peritonitis. Two patients underwent urgent surgery for progressive toxic megacolon and ineffective therapy. Subtotal colectomy and ileostomy were performed in all cases. Histological examination revealed necrosis of not only superficial layer of colon mucosa typical for clostridial colitis, but also the entire thickness of mucosa, as well as submucosal and partially muscular layers in some cases. Mucosal crypt atrophy, fibrinoid effusion in muscular layer, diffuse polymorphonuclear cell infiltration and necrosis of muscular and submucosal nerve plexuses, as well as necrosis of vascular walls with deposition of hyaline-like structures characterize microcirculatory ischemic processes in the colon wall. CONCLUSION: Severe pseudomembranous colitis associated with COVID-19 may not be associated with clostridial infection. Further analysis of possible ischemic etiology and pathogenesis of gastrointestinal lesions in COVID-19 is needed for preventive and therapeutic measures.

Postoperative complications in patients infected with COVID-19 (review of literature)

The article provides an analysis of the literature on the frequency and nature of postoperative complications in patients infected with a new coronavirus infection – COVID-19. Risk factors for the development of postoperative complications and mortality are considered;the presence of SARS-CoV-2 is a leading risk factor for these complications and mortality, significant risk factors are also patients age >70 years, male gender, cancer surgery, severity of the patient’s condition before surgery (3–5 points on the ASA scale), performance emergency operations, a significant amount of surgical interventions. Postoperative complications in patients with COVID-19 develop in 50 %, the mortality rate is 2 times higher compared with patients without coronavirus infection. © 2021 Vestnik Archeologii, Antropologii i Etnografii. All rights reserved.

Laparoscopic Surgery in Pandemic COVID-19

The review presents literature data on the peculiarities of laparoscopic procedures in case of new coronavirus infection COVID-19. The most important tasks in this case are to prevent hospital staff and patients from becoming infected. Measures for minimization of contacts, operation of operating theatres, protection of medical personnel are described in detail. Recommendations of surgeons-specialists from North America, China, Europe, who have considerable experience in performing laparoscopic operations under conditions of COVID-19 pandemic, are given. В обзоре представлены данные литературы об особенностях выполнения лапароскопических процедур при новой коронавирусной инфекции COVID-19. Важнейшими задачами при этом являются предотвращение больничного инфицирования медицинского персонала и пациентов. Подробно изложены мероприятия по минимизации контактов, работе операционных, защите медицинского персонала. Приведены рекомендации хирургов-специалистов из Северной Америки, Китая, Европы, имеющих значительный опыт выполнения лапароскопических операций в условиях пандемии COVID-19.