ABSTRACT
INTRODUCTION: This study primarily sought to evaluate the risk factors for toxic megacolon development and treatment outcomes in Clostridium difficile-positive COVID-19 patients, secondarily to determining predictors of survival. METHODS: During the second COVID-19 wave (May 2020 to May 2021), we identified 645 patients with confirmed COVID-19 infection, including 160 patients with a severe course in the intensive care unit. We selected patients with Clostridium difficile infection (CDI) (31 patients) and patients with toxic megacolon (9 patients) and analyzed possible risk factors. RESULTS: Patients who developed toxic megacolon had a higher incidence (without statistical significance, due to small sample size) of cancer and chronic obstructive pulmonary disease, a higher proportion of them required antibiotic treatment using cephalosporins or penicillins, and there was a higher rate of extracorporeal circulation usage. C-reactive protein (CRP) and interleukin-6 values showed significant differences between the groups (CRP [median 126 mg/L in the non-toxic megacolon cohort and 237 mg/L in the toxic megacolon cohort; p = 0.037] and interleukin-6 [median 252 ng/L in the group without toxic megacolon and 1127 ng/L in those with toxic megacolon; p = 0.016]). As possible predictors of survival, age, presence of chronic venous insufficiency, cardiac disease, mechanical ventilation, and infection with Candida species were significant for increasing the risk of death, while corticosteroid and cephalosporin treatment and current Klebsiella infection decreased this risk. CONCLUSIONS: More than ever, the COVID-19 pandemic required strong up-to-date treatment recommendations to decrease the rate of serious in-hospital complications. Further studies are required to evaluate the interplay between COVID-19 and CDI/toxic megacolon.
ABSTRACT
INTRODUCTION AND IMPORTANCE: This case report describes postoperative complications in a patient after hybrid oesophagectomy for oesophageal carcinoma after COVID pneumonia. The global COVID-19 pandemic affected cancer patients indicated for surgery. Covid 19 may worsen the results of oesophageal cancer surgery. More similar studies are needed. CASE PRESENTATION: A 69-year-old male was diagnosed with squamous cell carcinoma of the middle oesophagus based on PET/CT without disease generalisation. His stenotic tumour required a nutritive jejunostomy, with subsequent neoadjuvant radiochemotherapy indicated according to the CROSS protocol. The patient developed COVID pneumonia during the cancer therapy. After managing the COVID pneumonia, oncological therapy was completed and a hybrid oesophagectomy was performed 8 weeks later. Serious complications (respiratory failure, septic shock, anastomosis dehiscence) developed during the postoperative period. All complications were managed therapeutically. The patient was type IVb according to the Clavien-Dindo classification. CLINICAL DISCUSSION: Postoperative complications may develop in any patient operated for oesophageal carcinoma, especially if high-risk predictive factors are present. The question arises as to how much the post-COVID condition affected the onset of these serious complications. CONCLUSION: Post-COVID patients are at a risk of developing post-COVID syndrome, which may lead to a wide range of symptoms in the affected organs. Further studies on the relationship between COVID-19 and oesophagectomy for oesophageal carcinoma will be necessary to clarify the relationship between the complications during the postoperative period in patients with oesophageal malignancy.