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1.
Endoscopic Surgery ; 28(4):5-11, 2022.
Article in Russian | Scopus | ID: covidwho-2025839

ABSTRACT

Objective. The aim of the work was to analyze the results and treatment of acute appendicitis (AA) in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19. Material and methods. From March 16, 2020 to October 31, 2021, 139 patients with suspected AA were tread. In 104 patients (62 men and 42 women) the diagnosis of AA was confirmed. Inclusion criteria were: AA, a positive PCR (polymerase chain re-action) result for COVID-19, or a characteristic picture of viral pneumonia for COVID-19 based on computed tomography (CT). To clarify the diagnosis of acute appendicitis, all patients underwent CT scan of the abdominal organs. Results. When evaluating the symptoms of AA in patients with COVID-19, no specific signs were identified. The systematic inflammatory response could be due to both surgical disease and viral infection, making it difficult to interpret the chang-es. But, in 88 patients (84.61%) in the blood test was leukocytosis from 11.81 to 34.83·109/l, which is uncommon for patients with COVID-19 at the onset of the disease. The average time from the onset of clinical manifestations of AA to the operation was 57±14 hours. 139 diagnostic laparoscopies were performed. The diagnosis of AA was confirmed in 104 patients. 102 patients underwent laparoscopic appendectomy with pelvic drainage. One patient had laparotomy, appendectomy, intestinal intubation. One patient had laparoscopic resection of Meckel’s diverticulum plus appendectomy. A positive PCR result for SARS-CoV-2 effu-sion from the abdominal cavity was confirmed in 45 out of 75 patients (60%). According to the results of a pathomorphological study, 89 (85.58%) patients had phlegmonous appendicitis, 8 (7.69%) had gangrenous appendicitis, and 7 (6.73%) had gangre-nous-perforated appendicitis. Mortality was 0.96% (1 patient). Conclusion. Diagnostic problems of AA in patients with COVID-19 are associated with difficulties in interpreting local symptoms and systemic inflammatory response. Laparoscopy is the leading diagnostic method for suspected AA, including patients with COVID-19. In the absence of severe pneumonia, laparoscopic appendectomy is possible in most patients. All operations should be carried out in accordance with anti-epidemic measures. The clinical significance of detecting SARS-CoV-2 in the abdominal cavity needs further evaluation. The prognosis for patients is determined to a greater extent by the course of COVID-19. The tactics of treatment of patients with COVID-19, for whom surgical intervention is associated with an extremely high risk, needs to be clarified. © 2022, Media Sphera Publishing Group. All rights reserved.

2.
Endoscopic Surgery ; 27(6):5-13, 2021.
Article in Russian | Scopus | ID: covidwho-1771922

ABSTRACT

Objective. Aim of the study: to analyze the short-term treatment outcomes for patients with COVID-19 and hematomas of different localizations. Material and methods. The profile of hospital admissions of Sokolov North-West Regional Scientific and Clinical Center changed at November 6th, 2020. 1.878 patients with COVID-19 were admitted in the hospital from November 6th, 2020 and March 2nd, 2021. 25 people (1.1%) of admitted patients developed hematomas. The average age was 70±5.6 years. They were no mild forms of the disease. Anticoagulants were used in all cases from the 1st day of hospitalization. The volume of lung damage correspond-ed to CT-4 in 48% of patients, CT-3 in 2 (8%) patients and CT-2 — in 11 (44%) patients. The methods of diagnostic imaging of he-matomas were CT, ultrasound, and laparoscopy. Results. Hematomas were represented by deep intramuscular hematomas in 96% (24 patients). The typical localization of the he-matomas was rectus muscle of the anterior abdominal wall (12 patients). Chest wall hematoma was detected less often (5 pa-tients) and limb hematomas (3 patients). Retroperitoneal hematoma was observed in 2 patients, gluteal hematoma — in 1 patient. There was a combination of hematomas of various anatomical areas in 2 patients: in one patient — in the anterior abdominal wall and hip, in the second — in the anterior abdominal wall and pelvis. Blood transfusion was performed in 12 patients (48%). Risk factors of hematomas formation were: initially critical or fast progression of lung lesion volume in patients with COVID-19, co-morbidity of patients, the presence of obesity and an increased level of D-dimer. These risk factors were associated with intensified anticoagulant therapy. Out of 25 patients, 8 (32%) people underwent surgical procedures, hematoma punctures were performed in 6 (24%) patients, and 11 (44%) patients received conservative therapy. The mortality rate was 40% (10 patients). The cause of death was progressive pneumonia (9 patients) and disseminated intravascular coagulation syndrome (1 patient). Conclusion. Hematomas of different sites can occur in COVID-19 patients upon anticoagulation treatment. The decision making process in such cases should be determined by the severity of the patient’s condition and lung damage, the localization of the he-matoma, the amount of blood loss, the dynamics of the volume of the hematoma, and the proportion of the fluid component in it according to ultrasound or CT. The development of hematomas in COVID-19 patients is associated with poor prognosis. © 2021, Media Sphera Publishing Group. All rights reserved.

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