ABSTRACT
The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.
Subject(s)
Ascitic Fluid/virology , Betacoronavirus/isolation & purification , Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intestinal Perforation/surgery , Laparotomy , Pandemics , Pneumonia, Viral/transmission , Sigmoid Diseases/surgery , Viremia/transmission , Aerosols , Aged, 80 and over , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Cross-Sectional Studies , Diverticulum/complications , Fatal Outcome , Female , Humans , Intestinal Perforation/blood , Intestinal Perforation/complications , Intestinal Perforation/virology , Intraoperative Period , Nasopharynx/virology , Pandemics/prevention & control , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Postoperative Period , Prospective Studies , RNA, Viral/isolation & purification , Risk , SARS-CoV-2 , Serum/virology , Sigmoid Diseases/blood , Sigmoid Diseases/complications , Sigmoid Diseases/virology , Viremia/virologyABSTRACT
The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.