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1.
Ir Med J ; 113(6): 102, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32816437

RESUMO

Presentation A male patient with no significant past medical history presented to emergency department with progressive in severity abdominal pain, associated with mild nausea and diarrhea. No other significant symptoms were reported. Diagnosis On investigation with CT, duodenojejunitis was diagnosed as the cause of abdominal pain. Lung basal changes were also visualized and subsequently proven to be secondary to Covid-19 infection. Treatment After few days of hospitalization and supportive treatment, the patient improved clinically and was discharged. Conclusion Covid-19 infection typically presents with respiratory symptoms associated with fever and myalgia. Anorexia, diarrhea and nausea have been reported. Severe abdominal pain is rare, particularly as the initial presenting compliant. It is important to be aware of the varied clinical presentations that may occur in Covid-19, including isolated gastrointestinal symptoms. This will allow to increase the timely detectability of infected patients and more effective contact control measures.


Assuntos
Abdome Agudo/virologia , Infecções por Coronavirus/diagnóstico , Duodenite/virologia , Enterite/virologia , Doenças do Jejuno/virologia , Pneumonia Viral/diagnóstico , Abdome Agudo/diagnóstico por imagem , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Duodenite/diagnóstico por imagem , Serviço Hospitalar de Emergência , Enterite/diagnóstico por imagem , Humanos , Doenças do Jejuno/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32805726

RESUMO

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Assuntos
Abdome Agudo , Infecções por Coronavirus , Tratamento de Emergência , Gastroenteropatias , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Operatórios , Abdome Agudo/diagnóstico , Abdome Agudo/epidemiologia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Idoso , Betacoronavirus/isolamento & purificação , Testes de Coagulação Sanguínea/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/tendências
3.
Langenbecks Arch Surg ; 405(6): 861-866, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32720012

RESUMO

PURPOSE: Patients with an acute abdomen require emergency surgery. SARS-CoV-2 infection can affect multiple organ systems, including the digestive tract. Little is known about the consequences of COVID-19 infection in emergency surgical patients. METHODS: Perioperative data for COVID-19 patients undergoing emergency surgery from March 1, 2020, to May 23, 2020 were collected prospectively (NCT04323644). RESULTS: During this period, 215 patients underwent surgery, including 127 patients in an emergency setting, of whom 13 (10.2%) had COVID-19. Two scenarios were identified: (a) patients who were admitted to a hospital for an acute surgical condition with a concomitant diagnosis of COVID-19, and (b) patients with severe COVID-19 developing acute abdominal pathologies during their hospital stay. When compared with those in group B, patients in group A globally recovered better, with a lower mortality rate (14.3% vs. 33.3%), lower ARDS rate (28.5% vs. 50.0%), less rates of preoperative invasive ventilation (14.3% vs. 50.0%) and postoperative invasive ventilation (28.5% vs. 100.0%), and a shorter duration of invasive ventilation. No causality between SARS-CoV-2 infection and gastrointestinal affliction was found. CONCLUSION: Our observations underline that mild co-infection with COVID-19 did not result in more complications for emergency abdominal surgery. Howe, an acute abdomen during severe COVID-19 infection was part of an unfavorable prognosis.


Assuntos
Abdome Agudo/cirurgia , Abdome Agudo/virologia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Abdome Agudo/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Coinfecção , Infecções por Coronavirus/terapia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Taxa de Sobrevida , Resultado do Tratamento
4.
Chirurgia (Bucur) ; 115(3): 404-409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614297

RESUMO

Introduction: The GIST tumors are very rare entities ( 1% of all tumors). They originate in the Cajal interstitial cells, which are part of the autonomic nervous system of the intestine. Their most common location is the stomach, followed by the small intestine. The aim of this paper is to present a very rare case of perforated ileal GIST, associated with Meckel diverticulum. Case report: A 71 years old patient with comorbidities is admitted in emergency for symptoms and signs of acute surgical abdomen. The exploratory laparotomy reveals generalized acute peritonitis due to perforated ileal tumor and Meckel's diverticulum. A segmental enterectomy is performed, with favorable postoperative evolution. The histological examination of the resection piece shows the appearance of GIST, confirmed immunohistochemically. Conclusions: The GIST tumors of the small intestine are unusual tumors and the spontaneous perforation and life-threatening hemorrhage are a rarity. The main treatment for this form of GIST is the resection, with a favorable clinical outcome.


Assuntos
Abdome Agudo , Tumores do Estroma Gastrointestinal , Neoplasias do Íleo/complicações , Perfuração Intestinal , Divertículo Ileal , Idoso , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
5.
Am J Trop Med Hyg ; 103(2): 841-843, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32524962

RESUMO

SARS-CoV-2 infection can present with various clinical features, among which gastrointestinal manifestations such as nausea, diarrhea, vomiting, and mild abdominal pain have been reported. Recognition of rare presentations of SARS-CoV-2 infection has increased over time. These atypical and rare presentations may lead to difficulties in establishing the diagnosis in a timely manner; furthermore, they may lead to unnecessary investigations, extended hospital stays, adverse outcomes, and more strain on healthcare resources. We present three cases admitted to our hospital with a picture that mimicked an acute abdomen, necessitating surgical assessment and evaluation. All cases turned out to be SARS-CoV-2 positive and did not require surgical management. We discuss the management course, highlight the importance of abdominal symptoms in the setting of COVID-19, and discuss the implications of this association for medical practice amid the current pandemic in both resource-rich and resource-limited settings.


Assuntos
Abdome Agudo/virologia , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Abdome Agudo/diagnóstico por imagem , Adulto , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
7.
Ann R Coll Surg Engl ; 102(5): 323-332, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-155078

RESUMO

INTRODUCTION: Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. METHODS: A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. FINDINGS: Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. CONCLUSIONS: During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.


Assuntos
Abdome Agudo/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Salas Cirúrgicas/organização & administração , Pandemias , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Abdome Agudo/complicações , Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções/métodos , Laparoscopia/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumoperitônio Artificial/efeitos adversos , Prática Profissional/organização & administração , Procedimentos Cirúrgicos Operatórios/métodos
10.
Ulus Travma Acil Cerrahi Derg ; 26(3): 335-342, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: covidwho-185888

RESUMO

COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Serviço Hospitalar de Emergência , Pneumonia Viral/complicações , Ferimentos e Lesões/cirurgia , Abdome Agudo/cirurgia , Idoso , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Risco
15.
Ann R Coll Surg Engl ; 102(5): 323-332, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32352836

RESUMO

INTRODUCTION: Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. METHODS: A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. FINDINGS: Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. CONCLUSIONS: During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.


Assuntos
Abdome Agudo/cirurgia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Salas Cirúrgicas/organização & administração , Pandemias , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Abdome Agudo/complicações , Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções/métodos , Laparoscopia/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumoperitônio Artificial/efeitos adversos , Prática Profissional/organização & administração , Procedimentos Cirúrgicos Operatórios/métodos
17.
Orv Hetil ; 161(23): 977-979, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32453696

RESUMO

Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.


Assuntos
Peritonite/cirurgia , Abdome Agudo/etiologia , Adolescente , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Laparotomia , Masculino , Peritonite/diagnóstico , Choque Séptico/tratamento farmacológico
18.
Pediatr Infect Dis J ; 39(8): e195-e198, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32467457

RESUMO

We describe 5 children with severe SARS-CoV-2 infection, hemodynamic instability and suspected acute abdomen. This form of the disease has not been previously documented. Four of the cases were confirmed SARS-CoV-2 infection and 1 probable. All of them were previously healthy and needed a pediatric critical care unit admission. The respiratory symptoms were not dominant or were absent. Also, fever was observed. Laboratory testing revealed lymphopenia and high levels of C-reactive protein and procalcitonin with D-dimer, ferritin and interleukin-6 usually elevated. Respiratory support and inotropic support were almost always necessary. In all of them, deterioration occurred on the day of admission.


Assuntos
Abdome Agudo/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Centros de Atenção Terciária , Abdome Agudo/complicações , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/terapia , Adolescente , Betacoronavirus , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/terapia , Tosse , Febre , Hospitalização , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia , Pele/patologia , Espanha , Tórax/diagnóstico por imagem
20.
Ulus Travma Acil Cerrahi Derg ; 26(3): 335-342, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32394416

RESUMO

COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Serviço Hospitalar de Emergência , Pneumonia Viral/complicações , Ferimentos e Lesões/cirurgia , Abdome Agudo/cirurgia , Idoso , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Risco
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