Surgical treatment of acute intestinal obstruction in the infectious department environment for covid-19 patients.

Surgical care in a mono-hospital for patients with COVID-19 leads to a number of organisational problems due to the lack of specialised departments. The article presents the experience of surgical treatment in a mono-hospital obtained from one and a half years of work in this mode. In total, approximately 400 surgeries were performed. The experience of treatment of 7 patients with acute intestinal obstruction has been summarised. In the abdominal cavity, a significant number of hematomas of varied localisation were found under the parietal and visceral peritoneum, as well as in the subcutaneous fat. This is possibly associated with anticoagulant therapy included in the treatment regimen for patients with COVID-19 according to the methodical recommendations by the Ministry of Health of the Russian Federation. As an illustration, a successful case of treating COVID-19 patient with strangulated hernia of the abdominal white line complicated by acute intestinal obstruction is presented.Copyright © 2022, Krasnoyarsk State Medical University. All rights reserved.

Subacute Enteritis Two Months After COVID-19 Pneumonia With Mucosal Bleeding, Perforation, and Internal Fistulas.

Chronic sequelae of COVID-19 remain undetermined. We report a case of postinfection sequelae in a patient presenting with subacute obstruction 2 months after COVID-19 infection. A 34-year-old man with a prior prolonged hospital stay due to COVID-19 complicated by upper gastrointestinal (GI) bleed presented with subacute obstruction and failure to thrive. Upper GI push enteroscopy revealed residual ulcers and multiple proximal jejuno-jejunal fistulae. Midline laparotomy revealed strictures with dense intra-abdominal adhesions, a large jejuno-jejunal fistula, and evidence of prior jejunal perforation following severe COVID-19 infection. The patient recovered after small bowel resection with anastomoses and was discharged home. Histopathological examination of resected specimen confirmed transmural infarction with evidence of prior hemorrhage, diffuse ulcers, and multifocal inflammation. This is the first report of a chronic GI sequelae resulting from COVID-19. As the pandemic evolves, medical professionals must be vigilant to consider alternative GI diagnoses in the COVID-19 survivors.

A rare case of abdominal cocoon associated with internal hernia in an adult.

A transmesenteric internal hernia (TIH) is a protrusion of a viscus through the mesenteric defect. It is secondary to previous gastrointestinal surgery in an adult. Early diagnosis and management are warranted to prevent the strangulation of the bowel in a TIH. Here, we are reporting a case of a 24-year-old gentleman with COVID-positive status who has presented with cough, abdominal cocoon, and features of subacute intestinal obstruction (SAIO) without any previous history of abdominal surgery. A nonoperative trial is given in the management of abdominal cocoon with SAIO. In contrast, delay in surgical intervention in TIH leads to bowel gangrene. Surprisingly even on contrast-enhanced computed tomography of the abdomen, TIH was not picked up. We have diagnosed this case intraoperatively with gangrene of the bowel. In an abdominal cocoon without any history suggestive of tuberculosis or previous surgery, or any other condition that leads to an intra-abdominal reaction, an internal hernia should be kept as a differential diagnosis. The delay in diagnosis and surgical intervention is associated with potentially disastrous complications.

A Late Presentation of COVID-19 Induced Bowel Ischemia.

Introduction: Infection with COVID-19 may lead to extrapulmonary pathologies secondary to the systemic inflammatory effects of the virus. Case Description: This case report discusses a 55-year-old female patient who presented with small bowel obstruction (SBO) several months after resolution of a COVID-19 infection. The patient was surgically treated with a small bowel resection, and eventually made a full recovery. Discussion: The pathophysiology of COVID-19-induced SBO can be explained by the prolonged inflammation and coagulation activation in the bowel's vasculature system. Under these circumstances, microthrombosis occurs in the bowel's microvasculature; the affected intestinal tissue becomes ischemic and infarcted. The damaged bowel is eventually replaced with fibrotic scar tissue, thus promoting bowel stricture and subsequent obstruction. Conclusion: COVID-19 can be responsible for both acute and chronic embolic and thrombotic events in the mesenteric vasculature, which acts as a risk factor in the manifestation of SBO.

A Rare Case of COVID-19 Infection Leading to Colonic Stricture: Case Report and Review of Literature.

Coronavirus disease 2019 (COVID-19) predominantly targets the respiratory tract; despite gastrointestinal (GI) symptoms that may present in many patients, colonic strictures in coronavirus disease (COVID-19) patients are extremely rare and, to our knowledge, have never been reported. We, herein, present a case of a 59-year-old lady who developed intestinal obstruction due to colonic strictures shortly after recovering from complicated COVID-19 pneumonia. Ultimately, she underwent laparoscopic subtotal colectomy with ileorectal anastomosis. After a long recovery period, she was discharged in good status. It has been more than two years since COVID-19 was declared as a pandemic by the World Health Organization. Infected individuals have highly variable clinical manifestations, yet the pathogenesis, diagnosis and ideal management of each of these complications is not well described in literature.

Surgical treatment of acute intestinal obstruction in the infectious department environment for covid-19 patients

Surgical care in a mono-hospital for patients with COVID-19 leads to a number of organisational problems due to the lack of specialised departments. The article presents the experience of surgical treatment in a mono-hospital obtained from one and a half years of work in this mode. In total, approximately 400 surgeries were performed. The experience of treatment of 7 patients with acute intestinal obstruction has been summarised. In the abdominal cavity, a significant number of hematomas of varied localisation were found under the parietal and visceral peritoneum, as well as in the subcutaneous fat. This is possibly associated with anticoagulant therapy included in the treatment regimen for patients with COVID-19 according to the methodical recommendations by the Ministry of Health of the Russian Federation. As an illustration, a successful case of treating COVID-19 patient with strangulated hernia of the abdominal white line complicated by acute intestinal obstruction is presented. © 2022, Krasnoyarsk State Medical University. All rights reserved.

COVID-19 and related gastrointestinal symptoms: An observational study

Objective: COVID-19 pandemic has infected the entire world and causes obsolete morbidity and mortality. While respiratory symptoms are the most frequently reported, several recent studies revealed that gastrointestinal symptoms are not uncommon. Our aim in this observational study is to reveal the gastrointestinal symptoms of COVID-19 patients. Patients and Methods: Data of COVID-19 patients with gastrointestinal symptoms were recorded and retrospectively analyzed during their hospital follow-up period. 82 patients participated in the study and later on had a positive polymerase chain reaction (PCR) test. Gender, age, systemic and gastrointestinal complaints, medical and surgical disease history, laboratory results, thorax computer tomography (CT) findings, and characteristics of gastrointestinal system (GIS) symptoms of patients were also recorded. Data were analyzed by statistical software. Results: The most common typical symptoms of COVID-19 patients were cough, anosmia, debility, and shortness of breath. Further, most of the gastrointestinal symptoms found in COVID-19 patients were nonspecific abdominal pain. Lymphopenia and elevated liver transaminases were the most common findings of the tests. Patients with diarrhea indicated watery diarrhea. Two patients also had ileus, they healed spontaneously without surgical intervention. Furthermore, all patients were discharged without any problems. Conclusion: Gastrointestinal symptoms are typical in COVID-19 patients. However, these symptoms do not seem to have a detrimental effect on the progression of the disease. In our study group, there was no need for surgical intervention, but COVID-19 patients with gastrointestinal symptoms should be treated by a multidisciplinary approach.

Acute Pancreatitis with Colonic Pseudo-obstruction in a Patient with COVID-19.

Angiotensin-converting enzyme 2 receptor, the receptor used by severe acute respiratory syndrome coronavirus-2 (COVID-19) to infect cells, is found not only on respiratory epithelium but also in the small bowel, large bowel, and pancreas. There have been rare reports of acute pancreatitis (AP) in COVID-19 patients without an obvious etiology other than the underlying viral syndrome. We present a patient who was admitted with COVID-19 and developed AP and colonic pseudo-obstruction.

Obstructed Left Paraduodenal Hernia: A Rare Cause of Acute Abdomen in a COVID-19 Patient.

A paraduodenal hernia (PDH) is a rare type of internal hernia, which results from anomalous rotation and reduction of the midgut loop in the embryo. The diagnosis is often difficult due to nonspecific symptoms. The mortality from an acute internal hernia can be close to 50% when the diagnosis and definitive surgical treatment are delayed. Here we present a rare case of obstructed left paraduodenal hernia (LPDH) in a COVID-positive patient. This is probably the earliest report of acute mechanical intestinal obstruction due to LPDH in a COVID-positive patient.

Novel Coronavirus Infection in an Infant with Intussusception.

Background. Intussusception is the leading cause of intestinal obstruction in children under 4 years of age. Viral infections are the associated etiology in most cases, SARS-CoV-2 thereby being a plausible cause, although only 5 cases have been reported worldwide with both entities. We report a case of an infant with Intussusception and covid-19, its clinical approach, and surgical outcomes, throughout a retrospective review of electronic medical chart history with the authorization of the Ethics Committee on research of the "Hospital Universitario del Valle" and endorsement for publication. Case report. It is an 8-month-old male patient with 72 hours of fever 100.4°F; bloody diarrheal stools; episodic abdominal pain; signs of peritoneal irritation and sensation of a mass in the right quadrants of the abdomen. Intussusception confirmed by ultrasound led to surgery, with SARS-CoV-2 infection as a possible differential diagnosis. Surgical findings reported intussusception of the transverse colon, peritonitis, and intestinal ischemia of distal ileum and right colon, for which intestinal resection with consequent ileostomy and a mucous fistula was performed. Positive SARS-CoV-2 RT-PCR test result was confirmed. Pediatric intensive care unit support took place at the initial postoperative phase, and eventual intestinal, with enteral feeding tolerance at the fourth day, and respiratory improvement came off within the first week of medical and surgical treatment. Conclusion. Gastrointestinal symptoms are often the leading manifestations of COVID-19 in children, which can be isolated or as a common sign of a concomitant pathology such as intussusception, and they could also have a causal relationship.

Intussusception and SARS-CoV-2 infection.

We present 2 cases in the same city, of coexistence of intussusception and SARS-CoV-2 infection. The first in an 8 month old male in August 2020 and the second in a 7 month old female in October 2020; both resolved by surgical technique. Although it is known that some intussusception cases. can present concomitantly with viral infections, the fact that they appear in the same context as COVID-19 has only been reported as of late; these 2 new cases are added to the 6 reported so far. In the future, it will be analyzed whether this coexistence is the result of an association between the 2 diseases.

Anesthetic challenges while performing emergency laparotomy in a patient having COVID-19 infection.

An elderly hypertensive lady presented with fever, respiratory symptoms, and mild abdominal discomfort and was diagnosed to have COVID-19 pneumonia. Respiratory symptoms improved with steroids, awake proning, high flow nasal cannula oxygen therapy and antibiotics. After 4 days, she developed non-occlusive superior mesenteric artery thrombosis, which initially responded to anticoagulants but was complicated on tenth day by intestinal obstruction necessitating emergency surgery. Challenges encountered perioperatively were multi systemic involvement, pneumonia, ventilation- perfusion mismatch, sepsis along with technical difficulties like fogging of goggles, stuck expiratory valve on anesthesia machine, inaudibility through stethoscope and discomfort due to personal protective equipment. Perioperative focus should be on infection prevention, maintenance of hemodynamics, and optimization of oxygenation with preoperative high flow nasal cannula oxygen therapy. Ultrasound lung helps in correct placement of endotracheal tube. We recommend daily machine check, taping of N95 mask to face and ambient operation theatre temperatures of 20-22°C to reduce technical problems.