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1.
CMAJ ; 194(16): E590, 2022 04 25.
Article in English | MEDLINE | ID: covidwho-1938468

Subject(s)
COVID-19 , Abdomen , Humans , Stomach
2.
N Z Med J ; 135(1557): 10-18, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1904426

ABSTRACT

AIM: The purpose of this study was to determine the utility of community-based imaging to reduce use of inpatient surgical resources and enforce social distancing at the outset of the COVID-19 pandemic. METHOD: A prospective evaluation of community-based CT for patients presenting to Christchurch general practitioners with acute abdominal pain from April to November 2020. Eligible patients were discussed with the on-call general surgical team, and then referred for CT abdomen rather than hospital assessment. The positivity rate of CT scans, the 30-day all-cause hospital admission rate, and the proportion of patients where community scanning altered management setting and the number of incidental findings, were all assessed. RESULTS: Of 131 included patients, 67 (51%) patients had a positive CT scan. Thirty-nine (30%) patients were admitted to hospital within 30 days, 34 (87%) of whom had a positive CT scan and were admitted under a surgical specialty. Ninety-two (70%) patients did not require hospital admission for their acute abdominal pain, thirty-three (35%) of whom had a positive CT scan. There were three deaths within 30 days of the community CT, and the setting of the community CT did not contribute to the death of any of the cases. Forty patients (30%) had incidental findings on CT, 10 (25%) of which were significant and were referred for further investigation. CONCLUSION: Community based abdominal CT scanning is a feasible option in the management of acute abdominal pain. While trialed in response to the initial nationwide COVID-19 lockdown in New Zealand, there may be utility for acute community-based CT scanning in regular practice.


Subject(s)
Abdomen, Acute , COVID-19 , Abdomen , Abdomen, Acute/diagnostic imaging , Abdominal Pain/etiology , Communicable Disease Control , Humans , New Zealand/epidemiology , Pandemics , Retrospective Studies , Tomography, X-Ray Computed/methods
4.
Am J Emerg Med ; 59: 174-175, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1803388
5.
Abdom Radiol (NY) ; 47(5): 1565-1602, 2022 May.
Article in English | MEDLINE | ID: covidwho-1802663

ABSTRACT

BACKGROUND: Acute mesenteric ischemia (AMI) is a less common but devastating complication of COVID-19 disease. The aim of this systematic review was to assess the most common CT imaging features of AMI in COVID-19 and also provide an updated review of the literature on symptoms, treatment, histopathological and operative findings, and follow-up of these patients. METHODS: A systematic literature search of four databases: Pubmed, EMBASE, WHO database, and Google Scholar, was performed to identify all the articles which described abdominal CT imaging findings of AMI in COVID-19. RESULTS: A total of 47 studies comprising 75 patients were included in the final review. Small bowel ischemia (46.67%) was the most prevalent abdominal CT finding, followed by ischemic colitis (37.3%). Non-occlusive mesenteric ischemia (NOMI; 67.9%) indicating microvascular involvement was the most common pattern of bowel involvement. Bowel wall thickening/edema (50.9%) was more common than bowel hypoperfusion (20.7%). While ileum and colon both were equally involved bowel segments (32.07% each), SMA (24.9%), SMV (14.3%), and the spleen (12.5%) were the most commonly involved artery, vein, and solid organ, respectively. 50% of the patients receiving conservative/medical management died, highlighting high mortality without surgery. Findings on laparotomy and histopathology corroborated strikingly with CT imaging findings. CONCLUSION: In COVID-19 patients with AMI, small bowel ischemia is the most prevalent imaging diagnosis and NOMI is the most common pattern of bowel involvement. Contrast-enhanced CT is a powerful decision-making tool for prompt diagnosis of AMI in COVID-19, thereby potentially improving time to treat as well as clinical outcomes.


Subject(s)
COVID-19 , Mesenteric Ischemia , Abdomen , COVID-19/complications , Humans , Ischemia/complications , Mesenteric Ischemia/diagnostic imaging , Tomography, X-Ray Computed/methods
6.
Sci Rep ; 12(1): 6443, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1799564

ABSTRACT

As most COVID-19 patients only receive thoracic CT scans, but body composition, which is relevant to detect sarcopenia, is determined in abdominal scans, this study aimed to investigate the relationship between thoracic and abdominal CT body composition parameters in a cohort of COVID-19 patients. This retrospective study included n = 46 SARS-CoV-2-positive patients who received CT scans of the thorax and abdomen due to severe disease progression. The subcutaneous fat area (SF), the skeletal muscle area (SMA), and the muscle radiodensity attenuation (MRA) were measured at the level of the twelfth thoracic (T12) and the third lumbar (L3) vertebra. Necessity of invasive mechanical ventilation (IMV), length of stay, or time to death (TTD) were noted. For statistics correlation, multivariable linear, logistic, and Cox regression analyses were employed. Correlation was excellent for the SF (r = 0.96) between T12 and L3, and good for the respective SMA (r = 0.80) and MRA (r = 0.82) values. With adjustment (adj.) for sex, age, and body-mass-index the variability of SF (adj. r2 = 0.93; adj. mean difference = 1.24 [95% confidence interval (95% CI) 1.02-1.45]), of the SMA (adj. r2 = 0.76; 2.59 [95% CI 1.92-3.26]), and of the MRA (adj. r2 = 0.67; 0.67 [95% CI 0.45-0.88]) at L3 was well explained by the respective values at T12. There was no relevant influence of the SF, MRA, or SMA on the clinical outcome. If only thoracic CT scans are available, CT body composition values at T12 can be used to predict abdominal fat and muscle parameters, by which sarcopenia and obesity can be assessed.


Subject(s)
COVID-19 , Sarcopenia , Abdomen , Body Composition , COVID-19/diagnosis , COVID-19/diagnostic imaging , Humans , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology , Retrospective Studies , SARS-CoV-2 , Sarcopenia/diagnostic imaging , Sarcopenia/pathology , Tomography, X-Ray Computed
7.
Radiology ; 303(1): 182-183, 2022 04.
Article in English | MEDLINE | ID: covidwho-1752922
8.
Rev Esp Enferm Dig ; 114(7): 440, 2022 07.
Article in English | MEDLINE | ID: covidwho-1732539

ABSTRACT

In response to the publication "Acute appendicitis, foreign bodies and COVID-19 vaccination: correspondence", we reviewed the association between acute surgical abdomen and COVID-19 vaccination.


Subject(s)
Abdomen, Acute , Appendicitis , COVID-19 , Abdomen , Abdomen, Acute/etiology , Appendicitis/surgery , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Vaccination/adverse effects
9.
Am J Case Rep ; 23: e934049, 2022 Feb 05.
Article in English | MEDLINE | ID: covidwho-1675225

ABSTRACT

BACKGROUND Liposuction is a one of the most common aesthetic procedures. The super-wet and tumescent techniques are used most frequently. Both serve to reduce collateral blood loss, facilitate the suctioning procedure, and providing local anesthesia. Overall, liposuction is considered safe and effective, with minor adverse effects such as swelling, minute bleeding, contour irregularities, and seroma. Serious complication such as life-threatening bleeding are rare. In this case report, we present a patient with significant postoperative bleeding following minor-to-moderate liposuction performed at a day surgery center. CASE REPORT A 51-year-old healthy man, 4 days after 1600-cc aspirate tumescent liposuction performed in a day surgery center, was admitted to our ward with tachycardia, weakness, abdominal pain and disseminated hematoma. On admission, laboratory testing showed hematocrit of 20.9% and hemoglobin of 6.9 gr/dl. Immediate abdominal CT angiography was performed to exclude active bleeding, showing diffused hematoma in the subcutaneous fat all over the abdomen and scrotum, with some edema without active bleeding. The patient was treated with blood transfusion to facilitate fast home discharge during the peak of the COVID-19 epidemic that time. CONCLUSIONS We discuss the common work-up and treatment of postoperative hemorrhage. Blood transfusion following minor-to-moderate liposuction is unusual but during the COVID-19 pandemic it can facilitate quick discharge of a patient with postoperative hemorrhage with no active bleeding. Improper patient selection, an inexperienced surgeon, and inadequate operating locale can all result in postoperative complications. We call for the formulation of more detailed guidelines for liposuction setting.


Subject(s)
COVID-19 , Lipectomy , Abdomen , Ambulatory Surgical Procedures , Humans , Lipectomy/adverse effects , Male , Middle Aged , Pandemics , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/therapy , SARS-CoV-2
10.
Sci Rep ; 12(1): 1349, 2022 01 25.
Article in English | MEDLINE | ID: covidwho-1661975

ABSTRACT

Irrespective of its etiology, emergency surgical abdominal exploration (EAE) is considered a high-risk procedure with mortality rates exceeding 20%. The aim of this study was to evaluate differences in outcomes in patients who required EAE due to complications of complex elective abdominal procedures and those who required EAE due to high-risk primary abdominal emergencies. Patients undergoing EAE for acute surgical complications of complex abdominal elective surgical procedures (N = 293; Elective group) and patients undergoing EAE for high-risk primary abdominal emergencies (N = 776; Emergency group) from 2012 to 2019 at our institution were retrospectively assessed for morbidity and mortality. Postoperative complications occurred in 196 patients (66.94%) in the elective group and 585 patients (75.4%) in the emergency group. The relatively low complication burden in the elective group was also evidenced by a significantly lower comprehensive complication index score (54.00 ± 37.36 vs. 59.25 ± 37.08, p = 0.040). The in-hospital mortality rates were 31% (91 of 293) and 38% (295 of 776) in the elective and emergency groups, respectively. This difference between the two groups was statistically significant (p = 0.035). In multivariate analysis, age, peripheral artery disease, pneumonia, thromboembolic events, ICU stay, ventilator dependence, acute kidney failure and liver failure were independent predictors of mortality. Our data show that patients undergoing EAE due to acute complications of major elective surgery tolerate the procedure relatively well compared with patients undergoing EAE due to primary high-risk abdominal emergencies.


Subject(s)
Abdomen/surgery , Elective Surgical Procedures/adverse effects , Laparotomy/adverse effects , Postoperative Complications , Aged , Female , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies
11.
J Gastrointest Surg ; 26(1): 197-205, 2022 01.
Article in English | MEDLINE | ID: covidwho-1639085

ABSTRACT

BACKGROUND: The composite metric textbook outcome (TO) has recently gained interest as a novel quality measure. However, the criteria for defining a TO have not been rigorously defined and patient perspectives on the characteristics of TO are unknown. METHODS: Patients who underwent major abdominal surgery at a single tertiary care center were administered a customized survey designed to ascertain their perspectives on defining TOs. The relationship between patient-reported and clinically defined TO rates was compared. RESULTS: Among 79 patients who underwent gastrointestinal (51%), pancreatic (29%), hepatic (18%), or other major abdominal (3%) operations, 57% were female and 86% had an ASA class ≥3. Most patients underwent surgery for malignancy (87%) with 60% undergoing an open operation. Patients most commonly valued no mortality following surgery (96%), no reoperation (75%), and having a margin negative resection (73%) as "extremely important." In contrast, those outcomes that were most commonly valued as "not important at all" or "minimally important" were receiving a blood transfusion (24%) and not having any complications (13%). Using previously published criteria for TOs, 47 (60%) patients were classified as having a clinically defined TO; in contrast, 68 patients (86%) self-reported their outcome was textbook. Self-reported responses were concordant with clinically defined TO criteria 63% of the time (McNemar's test: S=15.2, p<0.01, evidence of disagreement). CONCLUSION: There was significant discordance between patient-reported versus clinically defined measures of TOs, suggesting patients value other considerations beyond traditional factors when evaluating the success of their surgery. Future studies should delineate these relationships and incorporate these factors to refine TO definitions.


Subject(s)
Abdomen , Blood Transfusion , Abdomen/surgery , Female , Humans , Reoperation , Treatment Outcome
12.
Chirurgia (Bucur) ; 116(6): 748-755, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1596438

ABSTRACT

Background: In the case of patients admitted with acute abdomen at the emergency department, interstitial pulmonary pathology (Covid-19 infections) represents a significant operative risk for the patients. The rate of postoperative complications is high with increased morbidity and mortality, a real challenge for the medical staff and surgical/intensive care unit teams. In emergency settings, patients were examined with targeted clinical and paraclinical parameters that assure a fast diagnosis to optimize a rapid medical and surgical treatment. Methods: We conducted a retrospective comparative study that included patients enrolled and diagnosed with an acute surgical abdomen in Surgical Clinic 1 Tg. Mures Emergency County Hospital. Patients were examined and analyzed at the emergency department UPU-SMURD. We included patients admitted over the two years (2019 and 2020) and divided them into two groups. Results: The total number of patients admitted in the UPU-Smurd emergency department Surgical Clinic I over the two years was 1033. There was a significant reduction in total cases diagnosed with the acute surgical abdomen in the pandemic period (p=0.033). The average time from the admission to the surgical procedure was significantly higher in the pandemic period 380Ã+-2 min in comparison with 222+-3 min (p=0.001) and also with an increased average operative time 223+-3 min versus 145+-2 min (p=0.002). Average hospitalization time was higher in the pandemic period 10+-1 (p=0.031) with no significant difference between the groups regarding Intensive Care Unit (ICU) admission (p=0.122). Overall mortality has more than doubled, with 31 cases (19%) in the pandemic and 28 (9%) in the non-pandemic. (p=0.001). Conclusions: The COVID-19 pandemic has played an essential role in treating acute surgical abdomen cases. The high solicitation rate of the emergency department delayed the diagnosis and treatment of severe surgical cases. As the scale of this pandemic is unprecedented, standard protocols with minor changes do not provide adequate results.


Subject(s)
Abdomen, Acute , COVID-19 , Abdomen , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Emergency Service, Hospital , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
14.
Abdom Radiol (NY) ; 47(5): 1565-1602, 2022 May.
Article in English | MEDLINE | ID: covidwho-1509228

ABSTRACT

BACKGROUND: Acute mesenteric ischemia (AMI) is a less common but devastating complication of COVID-19 disease. The aim of this systematic review was to assess the most common CT imaging features of AMI in COVID-19 and also provide an updated review of the literature on symptoms, treatment, histopathological and operative findings, and follow-up of these patients. METHODS: A systematic literature search of four databases: Pubmed, EMBASE, WHO database, and Google Scholar, was performed to identify all the articles which described abdominal CT imaging findings of AMI in COVID-19. RESULTS: A total of 47 studies comprising 75 patients were included in the final review. Small bowel ischemia (46.67%) was the most prevalent abdominal CT finding, followed by ischemic colitis (37.3%). Non-occlusive mesenteric ischemia (NOMI; 67.9%) indicating microvascular involvement was the most common pattern of bowel involvement. Bowel wall thickening/edema (50.9%) was more common than bowel hypoperfusion (20.7%). While ileum and colon both were equally involved bowel segments (32.07% each), SMA (24.9%), SMV (14.3%), and the spleen (12.5%) were the most commonly involved artery, vein, and solid organ, respectively. 50% of the patients receiving conservative/medical management died, highlighting high mortality without surgery. Findings on laparotomy and histopathology corroborated strikingly with CT imaging findings. CONCLUSION: In COVID-19 patients with AMI, small bowel ischemia is the most prevalent imaging diagnosis and NOMI is the most common pattern of bowel involvement. Contrast-enhanced CT is a powerful decision-making tool for prompt diagnosis of AMI in COVID-19, thereby potentially improving time to treat as well as clinical outcomes.


Subject(s)
COVID-19 , Mesenteric Ischemia , Abdomen , COVID-19/complications , Humans , Ischemia/complications , Mesenteric Ischemia/diagnostic imaging , Tomography, X-Ray Computed/methods
15.
Syst Rev ; 9(1): 98, 2020 04 30.
Article in English | MEDLINE | ID: covidwho-1455999

ABSTRACT

BACKGROUND: Gasless laparoscopy, developed in the early 1990s, was a means to minimize the clinical and financial challenges of pneumoperitoneum and general anaesthesia. It has been used in a variety of procedures such as in general surgery and gynecology procedures including diagnostic laparoscopy. There has been increasing evidence of the utility of gasless laparoscopy in resource limited settings where diagnostic imaging is not available. In addition, it may help save costs for hospitals. The aim of this study is to conduct a systematic review of the available evidence surrounding the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and open techniques and to analyze the benefits that gasless laparoscopy has for low resource setting hospitals. METHODS: This protocol is developed by following the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P). The PRISMA statement guidelines and flowchart will be used to conduct the study itself. MEDLINE (Ovid), Embase, Web of Science, Cochrane Central, and Global Index Medicus (WHO) will be searched and the National Institutes of Health Clinical Trials database. The articles that will be found will be pooled into Covidence article manager software where all the records will be screened for eligibility and duplicates removed. A data extraction spreadsheet will be developed based on variables of interest set a priori. Reviewers will then screen all included studies based on the eligibility criteria. The GRADE tool will be used to assess the quality of the studies and the risk of bias in all the studies will be assessed using the Cochrane Risk assessment tool. The RoB II tool will assed the risk of bias in randomized control studies and the ROBINS I will be used for the non-randomized studies. DISCUSSION: This study will be a comprehensive review on all published articles found using this search strategy on the safety and efficiency of the use of gasless laparoscopy. The systematic review outcomes will include safety and efficiency of gasless laparoscopy compared to the use of conventional laparoscopy or laparotomy. TRIAL REGISTRATION: The study has been registered in PROSPERO under registration number: CRD42017078338.


Subject(s)
Laparoscopy , Abdomen , Anesthesia, General , Humans , Pneumoperitoneum, Artificial , Systematic Reviews as Topic , United States
16.
Emerg Radiol ; 28(6): 1087-1096, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1446170

ABSTRACT

OBJECTIVES: To investigate what findings are new on contrast-enhanced abdominopelvic CT in patients infected with SARS-CoV-2. METHODS: Contrast-enhanced CT of the abdomen and pelvis of patients with COVID-19 at a tertiary oncologic center acquired over a 2-month period were reviewed independently by two readers and scored for new imaging abnormalities compared with a prior scan. CT scans were included if the study was performed between - 3 and 45 days from the time of COVID-19 diagnosis. Clinical information was gathered from the medical records. RESULTS: A total of 63 patients (34 male, 29 female; mean age 60.6 years, range 24.4-85.0 years) were included in this retrospective cross-sectional study. Aside from new ground glass opacities seen at the lung bases (29/63, 46.0%), the most common findings were new thickening of the stomach, small bowel or colon or fluid-filled colon (14/63, 22.2%), new small volume ascites (7/63, 14.3%), gallbladder distention in those without prior cholecystectomy (3/43, 7.0%), and single cases each of acute pancreatitis (1/63, 1.6%) as well as new portal vein thrombosis (1/63, 1.6%). CONCLUSION: Aside from lung base ground glass opacities, the most common new imaging abnormality on abdominopelvic CT in patients with COVID-19 finding in our cohort was abnormalities of the gastrointestinal tract, followed by small volume ascites, gallbladder distention, and isolated cases of pancreatitis and portal vein thrombosis. These findings overlap with those previously reported that did not have a prior scan for comparison, and provide supportive evidence that some of these findings may be related to SARS-CoV-2 infection.


Subject(s)
COVID-19 , Pancreatitis , Abdomen , Acute Disease , Adult , Aged , Aged, 80 and over , COVID-19 Testing , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed , Young Adult
18.
PLoS One ; 16(8): e0254698, 2021.
Article in English | MEDLINE | ID: covidwho-1354757

ABSTRACT

BACKGROUND: Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. METHODS: A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. RESULTS: In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. CONCLUSIONS: Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery.


Subject(s)
Abdomen/surgery , Chlorhexidine/therapeutic use , Models, Theoretical , Pneumonia/prevention & control , COVID-19 , Cost-Benefit Analysis , Humans , Mouthwashes , Pandemics , Postoperative Complications/prevention & control , Preoperative Care , Prospective Studies , South Africa
20.
Br J Radiol ; 94(1124): 20201220, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1309942

ABSTRACT

OBJECTIVES: With the increasing recognition of gastrointestinal (GI) manifestation of coronavirus disease-19 (COVID-19), various abdominal imaging findings are increasingly being noted. We scoped the existing literature on the abdominal imaging findings in COVID-19. METHODS: A systematic literature search was performed on PubMed, Embase, Google scholar and World Health Organization COVID-19 database. RESULTS: 35 studies were included in the final descriptive synthesis. Among the studies reporting positive abdominal imaging findings in patients with COVID-19, majority described imaging abnormalities of the GI tract (16 studies), of which bowel wall thickening was most frequently reported. Other findings noted were abdominal imaging manifestations of bowel ischemia with thrombosis of the splanchnic vasculature, and imaging features suggestive of pancreatitis. Imaging findings suggestive of solid organ infarction were reported in nine studies. An association between imaging evidence of hepatic steatosis and COVID-19 was noted in three studies. Incidental lung base findings on abdominal imaging were noted in 18 studies, where patients presented with predominant GI symptoms. The most common finding was bilateral ground glass opacities (90.7%) with predominant multilobar (91.1%) and peripheral (64.4%) distribution. CONCLUSION: This systematic review provides insight into the abdominal imaging findings in patients with COVID-19. Knowledge of these imaging manifestations will not only help in further research but also will aid in curtailing transmission of the SARS-CoV-2. Further prospective studies are needed to gain better insight into the pathophysiology of these imaging manifestations. ADVANCES IN KNOWLEDGE: This review highlights the abdominal imaging findings in patients with COVID-19, to gain insight into the disease pathophysiology and gear the abdominal radiologist through the pandemic.


Subject(s)
Abdomen/diagnostic imaging , COVID-19/complications , Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Diseases/etiology , Humans
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