ABSTRACT
PURPOSE: COVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound. METHODS: Children under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients' demographic, clinical, radiological and surgical characteristics were reviewed. RESULTS: Twenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months-18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel-small bowel intussusception which was surgically repaired. CONCLUSION: Given the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.
Subject(s)
COVID-19 , Ileal Diseases , Intussusception , Adolescent , Child , Enema , Humans , Ileal Diseases/diagnostic imaging , Ileal Diseases/etiology , Ileal Diseases/surgery , Infant , Intussusception/diagnostic imaging , Intussusception/surgery , Male , Retrospective Studies , SARS-CoV-2 , Treatment OutcomeSubject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Ileal Diseases/surgery , Intestinal Volvulus/surgery , Pneumonia, Viral/diagnostic imaging , Postoperative Complications/diagnostic imaging , COVID-19 , Female , Humans , Middle Aged , Pandemics , Postoperative Complications/etiology , SARS-CoV-2 , Tomography, X-Ray ComputedSubject(s)
COVID-19/transmission , Ileal Diseases/surgery , Intussusception/surgery , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Ileal Diseases/complications , Ileal Diseases/diagnostic imaging , Infant , Intussusception/complications , Intussusception/diagnostic imaging , Pandemics , Rotation , SARS-CoV-2 , UltrasonographyABSTRACT
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.