COVID-19 and acute biliary pancreatitis: comparative analysis between the normal period and COVID-19 pandemic.

BACKGROUND: The development of acute pancreatitis is multifactorial requiring predisposition and relevant injury.Viral acute pancreatitis has been described in other viral infections.However, pancreatic involvement in SARS-CoV-2 infection is still poorly defined.The present comparative study reports the patients with acute pancreatitis during the COVID-19 pandemic and last year covering the same period to appraise the link between COVID-19 and acute biliary pancreatitis. METHODS: The retrospective observational study was conducted in acute biliary pancreatitis patients from 13.03.19to13.09.19 and from 13.03.20to13.09.20 respectively. RESULTS: The study included 181patients(105patients in 2019;76 patients in 2020(during COVID-19 pandemic)).The patients were named as Group A(Normal period)and GroupB(Pandemic period),respectively.The groups were found to be comparable as there was no significant difference between the mean age, sex, comorbidities, cholecystectomized, and recurrency. There is no significant difference in the laboratory and radiological findings of GroupA and GroupB. However, there is a significant difference between the COVID-19 positive and negative patients in GroupB in terms of Glucose levels(p=0,025)and the presence of edema or necrosis in radiological images(p=0,046).There is a significant difference between the patients' number with abdominal pain of acute biliary pancreatitis in 2019and2020.(p=0)The length of stay was statistically significant in COVID-19 positive patients.(p= 0,013) CONCLUSIONS: Clinicians involved in the management of acute pancreatitis should be aware of its existence in the context of COVID-19.Understanding of the disease process and clinical manifestations of COVID-19 is still developing.Awareness of these issues and addressing them adequately will be crucial for the management. KEY WORDS: Acute Biliary Pancreatitis, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Comparative analysis of the management of acute appendicitis between the normal period and COVID-19 pandemic.

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period. METHODS: This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively. RESULTS: This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B. CONCLUSION: The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.

Is Mesenteric Ischemia In COVID-19 Patients A Surprise?

Aim. The disease caused by the 2019 novel coronavirus is known predominantly for its respiratory outcomes; a subset of critically ill patients demonstrates clinically remarkable hypercoagulability in which thrombotic events range from acute pulmonary embolism in patients with COVID-19 pneumonia to extremity ischemia. Our observational study aimed to describe the incidence and characteristics, as well as clinical outcomes, of patients presenting and treated for mesenteric ischemia during the COVID-19 pandemic. Material and Methods. Between March 13 and May 13, 2020, 60 patients operated for emergency reasons were analyzed, and it was noticed that 5 of the 6 COVID-positive patients were operated due to mesenteric ischemia. Results. Five of sixty patients (83.3%) applied to our emergency clinic with COVID-19 positive and acute abdomen. Two of them (40%) did not have any comorbidities. All of them (%100) were male. There were no complications and only 1 death (20%). Mean leukocyte, neutrophil, and platelet levels were within the normal range, while the lymphocyte level was near the lower limit. C-Reactive Protein was above the limit in all patients. The mean levels of International Normalized Ratio, Platelet, and Activated Partial Thromboplastin Time were above the limits. While D-dimer levels were close to the upper limit; fibrinogen levels were above the normal limit for each patient. Conclusion. The presence of hypercoagulation status in critical COVID-19 patients should be observed closely, and anticoagulation therapy can be considered in selected patients. More clinical data are needed to examine the role of anticoagulation in COVID-19 treatment.

COVID-19 Outbreak and Oncological Surgery Practice.

The emergence of COVID-19 has caused a global public health emergency. With the World Health Organization (WHO) reporting the novel coronavirus outbreak a pandemic, the focus is needed on the influence of this rapidly spreading viral infection on cancer patients. In this study, we aimed to address cancer-related operations during the COVID-19 outbreak. We retrospectively reviewed 26 patients who had undergone cancer surgeries admitted from March 13 to May 13, 2020, during the COVID-19 epidemic at Istanbul Bagcilar Training and Research Hospital, as a pandemic hospital. A total of 26 cases of COVID-19 were enrolled in the study. Seventeen (65%) were female, and 9 (35%) were male. The mean age was 52.4 (range 28-74). The mean body mass index (BMI) is 27.8 kg/m2 (range 17.6-34.0). Eight of them had comorbidities. 7 patients needed an intensive care unit (ICU). Only one patient was COVID-19 positive in the PCR test, while the others were negative. In addition to this patient, 3 other patients were COVID-19 positive on computed tomography (CT). The patients included in this study underwent various oncologic surgery procedures. While 24 patients were discharged without any problems, 2 patients developed complications. Due to respiratory problems, the patient could not get out of intensive care and died on the sixth postoperative day. It is the obligation of the institutions and the medical staff to reassure patients by creating safe postoperative surgical environments free of COVID-19. Surgeon leaders need to synthesize actual data to make the best decisions for their cancer patients.