Effective management of a firearm injury with multiple intestinal perforation in a COVID 19 positive patient: A rare case report.

ABSTRACT

INTRODUCTION: A challenging situation lies in front of every surgeon to perform emergency surgeries in a pandemic scenario. Gunshot injuries in a COVID-19 affected individual increases the chances of post-operative morbidity and mortality. Such cases require multidisciplinary approach with an advanced COVID care for the satisfactory outcome. CASE PRESENTATION We present a case of 30-year-old male with an alleged history of an accidental fire arm injury. His rapid antigen for COVID was positive. Contrast enhanced computed tomogram (CECT) abdomen was suggestive of multiple bowel injuries. Emergency exploratory laparotomy confirmed multiple bowel perforations with no associated solid organ injury. Perforated sites were sealed by primary repair and loop ileostomy was performed. Patient was discharged on post-operative Day 17 with satisfactory clinical improvement. DISCUSSION: Deleterious effects of COVID-19 has questioned the reliance on health care system across the globe. Pulmonary complications affect the post-operative course in patients undergoing surgery. However not every patient with peri operatively detected COVID-19 will have complicated post-operative course. Managing such patients with perioperative COVID-19 is an uphill task. Hemodynamic instability and clinical signs of peritonitis mandates the operative management. Multidisciplinary approach with advanced post-operative COVID care is required for satisfactory outcome. CONCLUSION: Management of patients undergoing emergency procedure with peri-operative COVID 19 is challenging for the attending surgeon. Consider all surgical emergencies as COVID positive unless proved otherwise. Multidisciplinary approach for management of COVID-19 infection along with good post-operative care is required.