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Introduction: Increasing evidence demonstrates the effectiveness of universal masking precautions in reducing the transmission of COVID-19. Whether these precautions have an impact on surgical site infections (SSI), currently remains unknown. This study assesses whether implementation of universal masking precautions altered the rates of SSI. Method(s): We performed a single-institution, retrospective cohort study using the NSQIP database, evaluating all patients undergoing most performed general surgery procedures from June 2018 to December 2021. SSI rates were compared between patients who underwent operation before and after implementation of universal masking precautions at our institution in March 2020. Statistical analyses were performed using Fisher's exact test. Result(s): A total of 1,539 patients were included;721 patients were in the pre-masking cohort, while 818 in post-masking cohort. During this time period, a total of 143 (9.3%) patients developed SSI, 3.6% incisional and 5.7% deep organ space infections (OSI) (p=0.6601). Incisional and OSI rates did not differ significantly between the two groups (incisional 3.47% vs 3.67%, p=0.891;OSI 5.41% vs 5.99%, p=0.6608). Sub-analysis of top 5 procedures (by volume - laparoscopic cholecystectomy, hepatectomy, thromboendarterectomy, colectomy with anastomosis, and colectomy with ileocolostomy) demonstrated a significant decrease in incisional infections (3.7% vs 1.62%, p=0.0354). Conclusion(s): While the incidence of SSI did not differ significantly in the overall cohort after implementation of universal masking precautions, there was a decrease in incisional infections in commonly performed procedures at our institution. Future research is needed to identify whether continued masking precautions may minimize the risk of SSI in specific patient populations.
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Introduction: The mortality rate of patients hospitalized with a lower gastrointestinal bleed has been reported at 1.1% in the United States from 2005 to 2014. Pseudoaneurysms, typically associated with pancreatitis, have been described in case reports as a rare condition with a small subset presenting as gastrointestinal bleeding. Our study describes a rare case of recurrent lower gastrointestinal bleeding diagnosed as a pseudoaneurysm by endoscopy and angiography. Case Description/Methods: A 38-year-old male presented to our facility from a long-term care facility with hematochezia and blood clots per gastrostomy-jejunostomy. He had recently been hospitalized for severe coronavirus disease 2019 with a complicated hospital course in the intensive care unit including necrotizing pancreatitis with an abdominal drain, multiple secondary infections, tracheostomy, and percutaneous endoscopic gastrostomy-jejunostomy. On previous hospitalization, he was found to have a small pseudoaneurysm of the gastroduodenal artery and received embolization of the gastroduodenal and gastroepiploic arteries at that time. During transport to our hospital, he was noted to have tachycardia, hypotension requiring norepinephrine, and was transfused one unit of red blood cells. Hemoglobin at this time was 7.5 g/dl after transfusion. Esophagogastroduodenoscopy was completed and showed a gastrojejunostomy tube in the expected location but was noted to be tight to the mucosa, which was pale in appearance. Flexible sigmoidoscopy revealed localized areas of edematous and erythematous mucosa with some associated oozing throughout the sigmoid colon. Repeat evaluation was completed one week later due to recurrent hematochezia. Colonoscopy was performed with identification of an apparent fistulous tract in the sigmoid colon located at 35 cm. Computed tomography angiography localized a pseudoaneurysm arising from the marginal artery of Drummond just proximal to its anastomosis with the ascending branch of the left colic artery and was successfully embolized. Discussion(s): Pseudoaneurysms, such as the one described in this case, have been shown to be associated with pancreatitis and can result if a pseudocyst involves adjacent vasculature. Gastrointestinal bleeding is a rare presentation of this condition. However, this case highlights the importance of repeat colonoscopy and angiography in the setting of a lower gastrointestinal bleed of unknown etiology.
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Purpose Regular practice, quality clinical exposure, and academic discussion are essential in any surgical specialty training. This study discusses and validates the option of using a fresh "chicken quarter" model with a measurable scoring system, as a standard training regimen in microvascular surgery. This can be a very effective, economical, and easily accessible model for residents. Materials and Methods This study was conducted in the Department of Plastic surgery, from October 2020 to May 2021. Twenty-four fresh "chicken quarter" specimens were dissected and the ischial arteries and femoral veins' external diameter (ED) were measured. The microsurgical skills of the trainee were assessed in 6 months intervals using the Objective Structured Assessment of Technical Skills Scale (OSATS) as well as the time taken for anastomosis. All the data were analyzed using SPSS (statistical package for social sciences) version 21. Results A task-specific score value of 50% on October 2020 improved to 85.7% by May 2021. This was found to be statistically significant ( p = 0.043). The mean ED of the ischial artery and femoral vein was 2.07 and 2.26 mm, respectively. The mean width of the vein measured at the lower one-third of the tibia was 2.08 mm. A greater than 50% reduction in anastomosis time was observed after a period of 6 months. Conclusion In our minimal experience, the "chicken quarter model" with OSATS scoring system seems to be effective, economical, very affordable, and easily accessible microsurgery training model for the residents. Our study is done only as a pilot project due to limited resources and we have the plan to introduce it as a proper training method in the near future with more residents.
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INTRODUCTION: Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas- Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients;COVID-19 further exacerbated this problem with restriction of elective surgical volume. METHOD(S): A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient. RESULT(S): A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes. CONCLUSION(S): We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.
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The proceedings contain 78 papers. The topics discussed include: work disability, indirect costs and risk factors in patients with Crohn's disease in a Rio De Janeiro tertiary care center;proton pump inhibitors are associated with less severe periodontal disease: considerations for IBD patients;impact of COVID-19 pandemic in treatment adherence in inflammatory bowel disease patients;impact of COVID-19 in a cohort of patients with inflammatory intestinal disease;utilization of biologic therapy in patients with microscopic colitis not responding to standard therapy;restrictive eating symptoms may persist in children adolescents with treated IBD: case series;power calculations in randomized controlled trials of inflammatory bowel disease;measuring patient-reported outcomes in Crohn's disease patients during the outbreak of COVID-19;Tofacitinib and ileal pouch anal anastomosis. a single-center case series;corticosteroids, aminosalicylates and gastrointestinal symptoms are associated with the need of hospitalization in patients with inflammatory bowel diseases and COVID-19;and manometric study and the role of the perianal disease and the clinical activity in anorectal dysfunction in Crohn's disease.
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Funding: None. Synopsis: 61-year-old male who initially presented to an outside facility with streptococcal pneumoniae meningitis and bacteremia. Of note, he had history of COVID-19 pneumonia a month prior. On hospital day 15, he reported sudden onset lower back pain prompting imaging which demonstrated a contained rupture of an infrarenal aortic aneurysm that had significantly evolved in comparison to admission imaging where his infrarenal aorta had the largest dimension measuring 2.9cm. We present the successful application of neoaortoiliac system (NAIS). Method(s): Proceeding with midline laparotomy we encountered dense adhesive disease due to his history of surgery for colon cancer. After adhesiolysis, we exposed the aorta and aneurysm with severe surrounding inflammatory changes. 20cm of femoral vein was harvested, reversed, and joined for a span of 4cm using an Endo GIA 45mm vascular load to create our neoaorta. Proximal and distal clamp zones were developed. Upon entering the aneurysm, a foul smell was encountered, revealing that the noxious process had destroyed the posterior wall of the aorta and paraspinal tissues. Our neoaorta was anastomosed in end-to-end fashion to the infrarenal aorta and subsequently to the common iliac arteries. Flow was initially restored to the hypogastric arteries and then the external iliac arteries. The retroperitoneum was closed over our repair and covered with omentum. Result(s): On post-operative day 2, he had hematochezia;intraoperatively, the IMA was noted to be 1mm in size, though had brisk back-bleeding and was ultimately ligated. A flexible sigmoidoscopy revealed ischemic sloughing of the sigmoid colon near his previous anastomosis from his colon cancer resection though no transmural necrosis. He remains on high-dose ceftriaxone to complete a 6-week course and metronidazole for 10 days due to his sigmoid mucosal ischemia per infectious disease recommendations. He is now post-operative day 10 and remains in the ICU. Conclusion(s): Mycotic aortic aneurysms constitute 1-1.8% of aortic aneurysms. The standard of treatment is aggressive debridement of involved aortic wall and periaortic tissue, in-situ or extra-anatomic reconstruction, coverage with an omental flap and long-term antibiotic therapy. NAIS is resistant to infection and aneurysmal dilation, however, is a time-consuming procedure with a mean completion time of 8 hours. Dorweiler et al. demonstrated that vascular reconstruction with femoral vein in infected aortoiliofemoral fields has a mortality of 9-10% with negligible rate of late complications (graft stenosis, thrombosis, and dilation) and that venous morbidity after femoral vein harvest is well tolerated. Clagett et al. demonstrated that NAIS fashioned from greater saphenous vein had a failure rate requiring intervention of 64% compared to 0% for those constructed with deep femoral vein. Lastly, it is important to note that our patient was previously COVID-19 positive. This case demonstrates that the sequela of COVID-19 may have been a significant factor in our patient's pathophysiology. As we continue to learn about the effects of COVID-19 on vascular pathology, we must keep a large repertoire of operative techniques at hand in order to treat complex presentations of vascular emergencies. [Formula presented] [Formula presented] [Formula presented] Institution: Orlando Health, Orlando, FLCopyright © 2022
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A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.
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Aims: Simulation is increasingly important in the training of paediatric urology;training time lost due to the Covid-19 pandemic, patient safety concerns and the uptake of technology (i.e., robotics) means that trainees must develop new methods of attaining operative competency. Laparoscopic pyeloplasty can be technically challenging and involves a steep learning curve to be confident in performing this procedure independently. We therefore aimed to develop a low-cost, high-fidelity model which trainees could create using easily available materials. Method(s): Unique Party Balloon (Unique Party Store)-1200 Scarlet Red (pack of 10) [2.34] were filled with cotton wool pads (2 packs of 50 rounds 1-Aldi) and fashioned into a kidney shape. Pink 102 latex Balloons (PABBEU) [4.99] were filled with a 50 ml of water to create the renal pelvis and superglued (Loctite pack of 3, Ryman) [4.99] to the kidney. Then Long Pastel Twisting Balloons (pack of 50)-[4.29] were attached over the tied end of the renal pelvis creating the ureter. The model was then secured into the Laparoscopic box trainer using Velcro Hook and Loop Coins (Syntego, 105 pack) [2.95]. Result(s): The model was utilised in departmental skills sessions. Feedback demonstrated the model provided a realistic feel performing the anastomosis due to the latex, water-filled, balloons. Total cost per model was 1.10 (20 models). Conclusion(s): We demonstrate a low-cost model of laparoscopic pyeloplasty which trainees can create easily themselves. However, further work will be needed to improve the model for anatomical relations, particularly crossing vessels.
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Introduction & Objectives: The frequency of involvement in the oncological process of the ureters in case of pelvis tumors ranges from 15 to 20%. The use of the appendix as a plastic material for the reconstruction of extended ureteral defects (EUD), including left-sided ones, remains debatable. The main goal of this study is evaluating the clinical and functional results after EUD repair using patchy transposition of the appendix. Material(s) and Method(s): Since August 2019 to June 2021, 8 laparoscopic surgeries were performed to replace the EUD using flap transposition of the appendix. Of these, 6 on the left (75%), 2 on the right (25%). 7 women (87.5%) and 1 man (12.5%) were operated on. Mean age 53+/-10.6 years. Average BMI 25.9 kg/m2. Etiology EUD: 25% radiotherapy (n2), 50% iatrogenic surgery (n4), 12.5% (n1) primary ureteral cancer, 12.5% (n1) non-Hodgkin's lymphoma. In all cases, the first stage was a wide mobilization of the ileocecal angle, the appendix was disconnected with a 45 mm hardware suture, in case of left-sided lesion, the appendix was moved isoperistaltically under the mesentery of the sigmoid colon to the left side after preliminary maximum mobilization of the process on the vascular pedicle in the form of a "triangle". All patients received a 7Fr ureteral stent. CT urography was performed on the 3rd, 7th, 11th days. Dynamic nephroscintigraphy was performed on the 90th day. Result(s): The average length of diastasis is 4.6+/-1.7 cm. The average length of the mobilized appendix was 8+/-1.8 cm. Replacement of the ureter with an appendix and a flap of the bladder according to the Demel method was performed in 1 case (12.5%), according to the Boari method in 1 case (12.5%), in 6 (75%) cases an anastomosis was formed according to the "end-to-end" type. the end". The average duration of the operation was 251+/-40.9 min, blood loss was 121+/-56.7 ml. Median removal of the ureteral stent was 36+/-18.28 days. Duration of hospital stay was 14+/-5.2 days. Median follow-up 10+/-5.3 months. Early complications (<30 days): 2 cases of urinary edema (Clavien-Dindo II), 2 cases of ipsilateral hydronephrosis (Clavien-Dindo I-II). Late complications (>30 days): 1 case of partial failure of ureterocystoanastomosis against the background of Sars-Cov-2 infection (Clavien-Dindo IIIa), 1 case of non-functioning left kidney (Clavien-Dindo IVa). Dynamic nephroscintigraphy was performed in 68.4% of patients, the average isotope accumulation time was 4.23+/-0.25 minutes, the duration of the half-life was 14.26+/-0.52 minutes. Conclusion(s): Flap transposition with the appendix is a technically difficult but possible option for extended ureteral strictures. However, various pathological processes that have developed against the background of previous treatment potentially increase the risk of developing repeated strictures or anastomotic leaks. Therefore, given the small sample of patients, further research on this issue is required.Copyright © 2023.
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INTRODUCTION: Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. We aim to report our mid-term follow-up of SASJ from a high-volume center for bariatric metabolic surgery in the Middle East region. METHODS: For the current study, the 18-month follow-up data of 43 patients with severe obesity who underwent SASJ was collected. The primary outcome measures were demographic data, weight change variables according to ideal body mass index (BMI) of 25 kg/m2 at 6, 12, and 18 months, laboratory assessments, remission of obesity-associated medical problems, and other potential bariatric metabolic complications after the surgery. RESULTS: No patient was lost due to follow-up. After 18 months, patients lost 43.4 ± 11 kg of their weight and 68 ± 14% of their excess weight, and their BMI decreased from 44.9 ± 4.7 to 28.6 ± 3.8 kg/m2 (p < 0.001). The percentage of total weight loss till 18 months was 36.3%. The T2D remission rate at 18 months was 100%. Patients neither faced deficiency in significant markers for nutrition state nor represented major bariatric metabolic surgery complications. CONCLUSION: SASJ bypass achieved satisfactory weight loss and remissions in obesity-associated medical problems within 18 months after surgery without major complications and malnutrition.
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Gastric Bypass , Malnutrition , Obesity, Morbid , Humans , Obesity, Morbid/surgery , Follow-Up Studies , Obesity/surgery , Anastomosis, Surgical/methods , Gastrectomy/methods , Weight Loss , Malnutrition/surgery , Gastric Bypass/methods , Retrospective Studies , Treatment OutcomeABSTRACT
Purpose: The classical colon substitution procedure is open surgery. Still, technological developments could allow a minimally invasive procedure that might improve patient outcomes. To present the efficacy and safety of esophagocolonic OrVil anastomosis after minimally invasive esophagectomy. Methods: This retrospective study included 10 patients with esophageal cancer treated with OrVil anastomosis (OA) between August 2017 and May 2021 at Department of Thoracic Surgery, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China and the Fourth Associated Hospital of Anhui Medical University. The patient's characteristic information and related perioperative indexes were collected from the hospital's electronic medical record system and the patients were followed up. Results: The mean operative time and median intraoperative blood loss were 530 ± 88 minutes and 200 (range: 100-300) mL, respectively. A median of 26 (range: 13-30) lymph nodes was dissected per patient. The median total duration of hospitalization and postoperative hospitalization was 32 (range: 24-64) and 15 (range: 12-42) days, respectively. Seven (70%) patients had postoperative pulmonary infections. Two (20%) patients had postoperative respiratory failure. No esophagocolonic anastomotic leakage was observed in all cases. One patient was complicated with postoperative colonicoduodenal anastomotic leakage after the operation and was cured. However, 1 (10%) of the remaining 9 patients died from colonicolonic anastomotic leakage during hospitalization. The living 9 cases were followed up, and the median overall survival time was 36 months. Conclusion: Colonic interposition for esophageal cancer is effective and safe using the minimally invasive OA technique.
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Background Surgical strategies to achieve biventricular (BiV) repair in children with borderline left ventricle (LV) continue to evolve. We report our innovative strategy of LV recruitment utilizing systemic to pulmonary artery shunt upsizing along with fenestrated atrial septation (FAS). Case The case is a 22mo old with hypoplastic left heart variant with type A aortic arch interruption and bilateral SVC. The LV, aortic and mitral valve were hypoplastic not meeting criteria for BiV repair. He underwent stage 1 palliation (Norwood with 4mm BTT shunt). Frequent COVID infections and over-circulation led to BiV dysfunction and cardiogenic shock requiring ECMO support for 4 days. At 5 months of age cardiac catheterization (CC) revealed good hemodynamic parameters for a stage 2 Glenn. An MRI also revealed growth of the left ventricle. Decision-making A decision was made to engage in a staged LV recruitment process to achieve BiV repair. We elected to avoid a volume offloading procedure in the form of a Glenn. To optimize continued volume loading on the LV, Stage 2 palliation consisted of upsizing to a 5mm BTT shunt with 4mm FAS. MRI at 22 months showed an LV volume of 60ml/m2 associated with CC hemodynamics showing LA pressure of 13mmHg, and LV end-diastolic pressure of 12mmHg. He underwent BiV repair with takedown of DKS, with primary anastomosis of the aorta and the pulmonary artery to their respective circulations. The postoperative echocardiogram illustrated a gradient of 5mmHg and 3mmHg through the mitral and aortic valve respectively. The pt was placed on a beta blocker and discharged on day 5 following BiV conversion. This strategy provides increased pulmonary blood flow with increased bloodflow across the mitral valve and inflow into the LV. In so doing may enhance the rate of LV growth. Furthermore, this strategy avoids the bidirectional Glenn (BDG), a volume offloading operation. Conclusion Shunt upsizing with FAS is well tolerated. It has the potential advantage for fewer operations to achieve BiV circulation due to rapid LV growth in comparison to other staged LV recruitment strategies involving the BDG.Copyright © 2023 American College of Cardiology Foundation
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Purpose: Men with idiopathic obstructive azoospermia (OA) are candidates for surgical reconstruction with a vasoepididymal anastomosis (VEA) performed on one or both testis. There are no randomised trials comparing the success of unilateral versus bilateral VEA. We conducted a randomised trial comparing the two surgical options. Material(s) and Method(s): Between April 2017 and March 2022, men with infertility due to idiopathic OA were randomised to unilateral (Group 1) or bilateral (Group 2) VEA in an ethics committee approved clinical trial registered with the Clinical Trials Registry. The primary outcome was successful surgery defined as appearance of sperms in the ejaculate, evaluated at 3 monthly intervals after surgery. Additional outcomes were pregnancy rates and complications between the two groups. Men with successful surgery were compared with those without patency to identify predictors of success. Result(s): 54 men fulfilled the criteria and 52 who completed follow-up were included in the analysis. Accrual did not reach the planned number of 70 subjects due to the COVID-19 pandemic. Success rate and spontaneous pregnancies were higher in men with bilateral surgery (46%, 3) than unilateral surgery (27%, 0) but were not statistically significant. Both groups had similar complication rates. Although bilateral surgery and presence of sperms in epididymal fluid were higher in men with patency, these were not statistically significant. Conclusion(s): Bilateral VEA was associated with higher patency and spontaneous pregnancy rates compared to unilateral surgery. Although the results were not statistically significant due to the underpowered study, they suggest a clinically significant outcome.
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Background: Anastomotic leak (AL) after minimally invasive esophagectomy (MIE) is a well-described source of morbidity for patients undergoing surgical treatment of esophageal neoplasm. With improved early recognition and endoscopic management techniques, the long-term impact remains unclear. Method(s): A retrospective review was conducted of patients who underwent MIE for esophageal neoplasm between January 2015 and June 2021 at a single institution. Cohorts were stratified by development of AL and subsequent management. Baseline demographics, perioperative data, and post-operative outcomes were examined. Result(s): During this period, 172 MIEs were performed, with 35 of 172 (20.3%) complicated by an AL. Perioperative factors independently associated with AL were post-operative blood transfusion (leak rate 52.9% versus 16.8%;p = 0.0017), incompleteness of anastomotic rings (75.0% vs 19.1%;p = 0.027), and receiving neoadjuvant therapy (18.5% vs 30.8%;p < 0.0001). Inferior short-term outcomes associated with AL included number of esophageal dilations in the first post-operative year (1.40 vs 0.46, p = 0.0397), discharge disposition to a location other than home (22.9% vs 8.8%, p = 0.012), length of hospital stay (17.7 days vs 9.6 days;p = 0.002), and time until jejunostomy tube removal (134 days vs 79 days;p = 0.0023). There was no significant difference in overall survival between patients with or without an AL at 1 year (79% vs 83%) or 5 years (50% vs 47%) (overall log rank p = 0.758). Conclusion(s): In this large single-center series of MIEs, AL was associated with inferior short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, without an accompanying impact on 1-year or 5-year survival. Key message: In this large, single-center series of minimally invasive esophagectomies, anastomotic leak was associated with worse short-term outcomes including hospital length of stay, discharge disposition other than to home, and need for additional endoscopic procedures, but was not associated with worse long-term survival. The significant association between neoadjuvant therapy and decreased leak rates is difficult to interpret, given the potential for confounding factors, thus careful attention to modifiable pre- and peri-operative patient factors associated with anastomotic leak is warranted.Copyright © 2022 The Authors
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Background: COVID-19 is associated with thrombotic complications and can result in hepatobiliary injury. Excellent early outcomes have been reported in recipients of solid non-lungs organs from SARS-CoV-2-infected donors, however longer follow-up data are lacking. We aimed to describe the medium-term outcome of our liver transplants (LT) from COVID-19 donors. Methods: From 11/2020 to 03/2022, we consecutively enrolled all patients who received a graft from COVID-19 donor in our Centre. Protocol liver biopsy and magnetic resonance cholangiopancreatography (MRCP) after 1-year from LT were reported. Results: In the study period 12/213 (5.6%) adult LT patients received a COVID-19 donor (11 active, 1 resolved COVID-19)1. Eleven patients underwent end-to-end biliary anastomosis and 1 biliodigestive anastomosis. Recipients' and donors' characteristics are reported in table 1. Two recipients tested SARS-CoV-2 RNA positive on nasopharyngeal swab at LT and one was treated with sotrovimab on day-1 after LT. None of the patients developed COVID-19 after LT. One patient underwent hepatic artery thrombectomy at day-1 and died after 320 days for HCC recurrence. Until now: -10 patients underwent protocol MRCP (median time from LT 562 days, IQR 245-614), which showed: 7 no visible abnormalities, 1 donor-recipient's bile duct size discrepancy, 2 caliber changes <50% at the anastomotic level (untreated for the absence of cholestasis);-7 patients underwent protocol liver biopsy (median time from LT 553 days, IQR 311-557) which showed 1 acute cellular rejection (RAI 4/9) successfully treated with steroids;no signs of fibrosis, rejection or biliopathy in the other 6 patients. Conclusions: 11/12 patients who received a LT from COVID-19 donors are alive, without evidence of SARS-CoV-2 transmission. At a median follow-up of 1.5 years, protocol liver biopsy and MRCP did not show biliopathy, supporting the utilization of COVID-19 donors to expand the donor pool and reduce the waiting list mortality.
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Background: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID-19) and perform a systematic review of the literature. Case description and systematic review: A 45-year-old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID-19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post-viral illness (post-COVID-19 [n = 3], and influenza [n = 1]), and post-intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26;19.2%) or bronchoscopic instillation (1/26;3.8%) of amphotericin B and surgery (6/26;23.1%) were performed in some patients. The case-fatality rate was 50%, primarily attributed to massive haemoptysis. Conclusion: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible. © 2022 Wiley-VCH GmbH.
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Aim is to discuss diagnostic and therapeutic difficulties in COVID-19 related postoperative outcomes. A 5-year-old boy operated for jejunal atresia in neonatal period admitted with recurrent bilious vomiting. The upper GI series revealed dilated jejunum and absence of mechanical obstruction. The dilated jejunal segment was excised and anastomosis was performed. Later, he developed peritonitis without signs of anastomotic leaks. The second surgical exploration revealed diffuse peritonitis causing thickened and fibrous bowel loops causing hardly lysable adhesions. Then, his grandmother was learned to be COVID-PCR positive. Therefore, patients with atypical postoperative course should be investigated for possible COVID-19 during pandemics. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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BACKGROUND: Acute mesenteric ischemia (AMI) may present in COVID-19 patients without the classic risk factors of AMI, and the symptoms might confuse physicians, leading to delayed diagnosis and increased mortality. In this manuscript, we report a patient with COVID-19 who presented with AMI as its initial presenting symptom. CASE PRESENTATION: A 68-year-old man presented to the emergency room with periumbilical non-radiating pain that had started three days before the admission. He had no defecation or gas passing in the past three days. In the physical exam, the patient had guarding of the abdomen, generalized tenderness, and rebound tenderness. C-reactive protein, Creatine phosphokinase and WBC count were elevate. Abdominal X-ray in the supine position was suggestive of obstruction of the small intestine. Diagnostic laparotomy was performed because of peritonitis and acute abdominal pain. The diagnosis was mesenteric ischemia due to vein thrombosis based on laparotomy and paraclinic findings. In the post-surgery evaluations COVID-19 infection was confirmed based on PCR and chest CT scan. DISCUSSION: Based on paraclinical, clinical, and diagnostic laparotomy findings, the patient was diagnosed with small bowel obstruction and gangrene due to acute mesenteric ischemia (AMI). But as described, this patient didn't have any history of medical diseases that cause a hypercoagulable state, in the past. While AF was ruled out because his ECG was normal. We concluded that in this patient AMI was due to his infection with COVID-19. CONCLUSION: Patients with COVID-19 may not have the typical risk factors for AMI, and AMI diagnosis should be considered in patients presenting with acute abdominal pain, even without the routine risk factors.
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Aim: The SARS-Cov- 2 pandemic has been undoubtedly overwhelming for elective colorectal cancer resections. However, early establishment of a green pathway has enabled our trust to operate in a clean, covid-19 free environment and this project aims to demonstrate this pathway. Method(s): Elective colorectal cancer resections have been included in this cohort from January until July 2020. Emergency and benign resections have been excluded from this study. The main procedures that have been performed were laparoscopic right hemicolectomies and high anterior resections. Complication rate was classified using the Clavien-Dindo scale. Patients from March 2020 onwards were operated and nursed post-operatively on a green covid-19 pathway. Result(s): A total of 62 patients were included in this study. Resections were mainly performed laparoscopically (85%) and these were mainly right hemicolectomies (41%) and high anterior resections (31%). There has been a single Covid19 positive resection and that was before the pathway has been established. The median length of stay was 5 days for all resections. The main post-operative complication was ileus and there were no anastomotic leaks. Conclusion(s): Elective colorectal resections during a respiratory pandemic are safe and feasible with appropriately established pathways.