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1.
Surg Endosc ; 36(6): 4290-4298, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1838333

ABSTRACT

BACKGROUND: Ileal Crohn's disease (CD) complicated by intraabdominal abscess, phlegmon, fistula, and/or microperforation is commonly treated with antibiotics, bowel rest, and percutaneous drainage followed by interval ileocolic resection (ICR). This "cool off" strategy is intended to facilitate the safe completion of a one-stage resection using a minimally invasive approach and minimize perioperative complications. There is limited data evaluating the benefits of delayed versus early resection. METHODS: A retrospective review of a prospectively maintained inflammatory bowel disease (IBD) database at a tertiary center was queried from 2013-2020 to identify patients who underwent ICR for complicated ileal CD confirmed on preoperative imaging. ICR cohorts were classified as early (≤ 7 days) vs delayed (> 7 days) based on the interval from diagnostic imaging to surgery. Operative approach and 30-day postoperative morbidity were analyzed. RESULTS: Out of 474 patients who underwent ICR over the 7-year period, 112 patients had complicated ileal CD including 99 patients (88%) with intraabdominal abscess. Early ICR was performed in 52 patients (46%) at a median of 3 days (IQR 2, 5) from diagnostic imaging. Delayed ICR was performed in 60 patients (54%) following a median "cool off" period of 23 days of non-operative treatment (IQR 14, 44), including preoperative percutaneous abscess drainage in 17 patients (28%). A higher proportion of patients with intraabdominal abscess underwent delayed vs early ICR (57% vs 43%, p = 0.19). Overall, there were no significant differences in the rate of laparoscopy (96% vs 90%), conversion to open surgery (12% vs 17%), rates of extended bowel resection (8% vs 13%), additional concurrent procedures (44% vs 52%), or fecal diversion (10% vs 2%) in the early vs delayed ICR groups. The median postoperative length of stay was 5 days in both groups with an overall 25% vs 17% (p = 0.39) 30-day postoperative complication rate and a 6% vs 5% 30-day readmission rate in early vs delayed ICR groups, respectively. Overall median follow-up time was 14.3 months (IQR 1.2, 24.1) with no difference in the rate of subsequent CD-related intestinal resection (4% vs 5%) between the two groups. CONCLUSIONS: In this contemporary series, at a high-volume tertiary referral center, a "cool off" delayed resectional approach was not found to reduce perioperative complications in patients undergoing ICR for complicated ileal Crohn's disease. Laparoscopic ICR can be performed within one week of diagnosis with low rates of conversion and postoperative complications.


Subject(s)
Abdominal Abscess , Crohn Disease , Laparoscopy , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Abscess/etiology , Abscess/surgery , Anastomosis, Surgical/adverse effects , Colectomy/adverse effects , Crohn Disease/complications , Crohn Disease/surgery , Humans , Laparoscopy/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Treatment Outcome
2.
In Vivo ; 36(3): 1325-1332, 2022.
Article in English | MEDLINE | ID: covidwho-1818959

ABSTRACT

BACKGROUND/AIM: COVID-19 is rapidly spreading, and due to the high morbidity and mortality caused by the pandemic many Governments have introduced social restrictions. Those measures combined with infection-related patient anxiety, led to hiding other diseases. The aim of this study was to evaluate the impact of COVID-19 on numbers and severity of acute appendicitis cases referred during the pandemic. PATIENTS AND METHODS: Between March 2019 and March 2021, all patients who underwent appendectomy in Tor Vergata Hospital, Rome were included. Patients were divided in two groups (COVID-19/pre-COVID-19). Clinical features, intraoperative findings, hospital stay, and histologic examination data were included in the retrospective analysis. RESULTS: Out of 334 admitted patients, 36 (10.7%) had a diagnosis of acute appendicitis (COVID-19 group) vs. 59(11.2%) in the pre-COVID-19 group. The COVID-19 group presented significantly longer hospitalization, incidence of appendicular abscess, perforation, and severity of inflammation at univariate analysis p=0.002, p=0.021, p=0.001, p=0.006, p=0.001, respectively. At multivariate analysis, appendicular abscess (p=0.015) and higher serum levels of C reactive protein (p<0.008) were associated with prolonged hospital stay. CONCLUSION: This study highlights the correlation between COVID-19 pandemic and the severity of acute appendicitis presentations.


Subject(s)
Appendicitis , COVID-19 , Laparoscopy , Abscess/complications , Abscess/surgery , Acute Disease , Appendicitis/epidemiology , Appendicitis/surgery , COVID-19/epidemiology , Hospitalization , Humans , Incidence , Pandemics , Retrospective Studies
4.
Ann R Coll Surg Engl ; 104(6): e193-e195, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1705768

ABSTRACT

Orbital cellulitis is a condition with a high risk of morbidity, including visual loss. It commonly originates from the paranasal sinuses. We present a case of multifocal intraorbital abscesses secondary to viral sinusitis in an adolescent with SARS-CoV-2 infection. This patient presented with classic symptoms of orbital cellulitis, but did not display classical symptoms of COVID-19. The patient initially underwent endoscopic drainage, followed by a combined approach which yielded no pus. He recovered without complication. This is the second report of its type showing a causative link between SARS-CoV-2 and orbital cellulitis.


Subject(s)
COVID-19 , Orbital Cellulitis , Abscess/diagnostic imaging , Abscess/etiology , Abscess/surgery , Adolescent , Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Cellulitis/drug therapy , Humans , Male , Orbital Cellulitis/diagnosis , Orbital Cellulitis/drug therapy , Orbital Cellulitis/etiology , Retrospective Studies , SARS-CoV-2
5.
Acad Emerg Med ; 27(11): 1150-1157, 2020 11.
Article in English | MEDLINE | ID: covidwho-1455493

ABSTRACT

BACKGROUND: There is limited research on loop drainage (LD) compared to incision and drainage (I&D) for treatment of cutaneous abscesses. We investigated whether LD was noninferior to I&D for abscess resolution and whether there was any difference in repeat ED visits or complication rates between these techniques. METHODS: We performed a prospective randomized controlled trial, using a convenience sample at an urban academic emergency department (ED). Subjects over 18 years who presented for first-time management of an abscess were eligible. Patients requiring specialist drainage or hospital admission or had previous treatment for the abscess were excluded. Enrolled subjects were seen 2 weeks after treatment for blinded reevaluation of abscess resolution, and the electronic medical record was reviewed for return ED visits/abscess complications. RESULTS: Of 2,889 patients screened, 238 subjects consented and were randomized to LD or I&D. Abscess resolution was achieved in 53/65 (81.5%) of patients in the I&D arm, compared to 66/75 (88%) in the LD arm. Fewer patients in the LD group compared to the I&D group returned to the ED for abscess-related management during the following 14 days (37.3% vs 67.1%, p = 0.002). Among returning subjects, there was a significant difference in mean visits per subject between LD and I&D groups (0.5 vs. 1.2, p = 0.001). There were fewer complications among LD than I&D subjects (9.3% vs. 24.6%, p = 0.01). CONCLUSION: Our study provides evidence that LD is noninferior to I&D in achieving complete abscess resolution at 14 days and is associated with fewer return ED visits and fewer complications. This makes it an attractive alternative treatment option for abscesses.


Subject(s)
Abscess , Skin Diseases , Abscess/surgery , Drainage , Emergency Service, Hospital , Humans , Prospective Studies , Skin Diseases/surgery
6.
Eur J Trauma Emerg Surg ; 47(3): 677-682, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1212849

ABSTRACT

PURPOSE: To evaluate and analyze the impact of lockdown strategy due to coronavirus disease 2019 (COVID-19) on emergency general surgery (EGS) in the Milan area at the beginning of pandemic outbreak. METHODS: A survey was distributed to 14 different hospitals of the Milan area to analyze the variation of EGS procedures. Each hospital reported the number of EGS procedures in the same time frame comparing 2019 and 2020. The survey revealed that the number of patients during the COVID-19 pandemic outbreak in 2020 was reduced by 19% when compared with 2019. The decrease was statistically significant only for abdominal wall surgery. Interestingly, in 2020, there was an increase of three procedures: surgical intervention for acute mesenteric ischemia (p = 0.002), drainage of perianal abscesses (p = 0.000285), and cholecystostomy for acute cholecystitis (p = 0.08). CONCLUSIONS: During the first COVID-19 pandemic wave in the metropolitan area of Milan, the number of patients operated for emergency diseases decreased by around 19%. We believe that this decrease is related either to the fear of the population to ask for emergency department (ED) consultation and to a shift towards a more non-operative management in the surgeons 'decision making' process. The increase of acute mesenteric ischaemia and perianal abscess might be related to the modification of dietary habits and reduction of physical activity related to the lockdown.


Subject(s)
Abscess , Anus Diseases , COVID-19 , Cholecystitis, Acute , Infection Control , Mesenteric Ischemia , Surgical Procedures, Operative , Abscess/epidemiology , Abscess/surgery , Adult , Anus Diseases/epidemiology , Anus Diseases/surgery , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Emergency Service, Hospital/statistics & numerical data , Female , General Surgery/trends , Health Services Misuse/statistics & numerical data , Humans , Incidence , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Mesenteric Ischemia/epidemiology , Mesenteric Ischemia/surgery , SARS-CoV-2 , Surgery Department, Hospital/statistics & numerical data , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data
7.
Heart Surg Forum ; 24(2): E372-E374, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1199988

ABSTRACT

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.


Subject(s)
Abscess/microbiology , Abscess/surgery , Aortic Diseases/microbiology , Aortic Diseases/surgery , COVID-19/complications , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/surgery , Heart Failure/etiology , Heart Failure/therapy , Abscess/diagnostic imaging , Adult , Aortic Diseases/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Heart Failure/diagnostic imaging , Humans , Male , Pleural Effusion/diagnostic imaging , Pleural Effusion/microbiology , Pleural Effusion/surgery , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Respiration, Artificial , SARS-CoV-2
9.
J Gastrointest Surg ; 25(1): 282-286, 2021 01.
Article in English | MEDLINE | ID: covidwho-743756

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the experience of surgery in IBD patients during the COVID pandemic. METHODS: A survey was distributed among patients undergoing IBD-related surgeries from January 2020 to March 2020 via an online platform. The response was submitted anonymously. RESULTS: A total of 78 patients responded to the survey. COVID-19 testing was conducted in 60 (76.9%) patients, and they were all tested negative. Emergent surgery was performed in 12 (15.4%) patients and postponed surgery in 18 (23.1%) patients. The surgical indications were mainly bowel obstruction (N = 21, 26.9%) and perianal abscess (N = 18, 23.1%). Postoperative complications were noted in 5.1% of cases, but no re-operation was required. Due to the ongoing COVID pandemic, 58 (74.4%) patients reported various levels of concern and anxiety for surgery. CONCLUSIONS: Common surgical indications were for bowel obstruction and perianal abscess. Surgery can be postponed, but disease progression should be monitored closely and surgically intervened as needed. Most patients expressed anxiety resulting from the pandemic. The overall experience was satisfactory.


Subject(s)
Abscess/surgery , Anxiety/psychology , COVID-19 , Digestive System Surgical Procedures/psychology , Hospitalization , Inflammatory Bowel Diseases/surgery , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , Abscess/etiology , Adult , COVID-19 Testing , Female , Hospitals , Humans , Inflammatory Bowel Diseases/complications , Intestinal Obstruction/etiology , Intestinal Perforation/etiology , Male , Middle Aged , Pandemics , Postoperative Complications/epidemiology , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
10.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-646934

ABSTRACT

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Subject(s)
Coronavirus Infections/epidemiology , Digestive System Surgical Procedures , Emergencies , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Respiratory Insufficiency/epidemiology , Respiratory Tract Infections/epidemiology , Abscess/surgery , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy , Betacoronavirus , COVID-19 , Cholecystectomy, Laparoscopic , Comorbidity , Coronavirus Infections/therapy , Disease Outbreaks , Drainage , Female , Herniorrhaphy , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Embolism/drug therapy , Pulmonary Embolism/epidemiology , Respiratory Insufficiency/therapy , Respiratory Tract Infections/therapy , Retrospective Studies , SARS-CoV-2 , Surgical Wound Infection/drug therapy , Surgical Wound Infection/epidemiology , United Kingdom/epidemiology , Young Adult
11.
Int J Surg ; 80: 157-161, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-644648

ABSTRACT

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Subject(s)
Abscess/surgery , Appendicitis/surgery , Cholecystitis, Acute/surgery , Coronavirus Infections/epidemiology , Intestinal Obstruction/surgery , Mortality , Pneumonia, Viral/epidemiology , Postoperative Complications/epidemiology , Rectal Diseases/surgery , Abdominal Wall , Abscess/epidemiology , Acute Disease , Appendectomy/statistics & numerical data , Appendicitis/epidemiology , Betacoronavirus , COVID-19 , Cholecystitis, Acute/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Dyslipidemias/epidemiology , Emergencies , Female , Hernia, Abdominal/epidemiology , Hernia, Abdominal/surgery , Herniorrhaphy/statistics & numerical data , Humans , Hypertension/epidemiology , Intestinal Obstruction/epidemiology , Laparoscopy/statistics & numerical data , Logistic Models , Male , Middle Aged , Myocardial Ischemia/epidemiology , Pandemics , Rectal Diseases/epidemiology , Reoperation/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Spain/epidemiology , Time-to-Treatment/statistics & numerical data
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