Bowel Perforation in Covid-19 Case Series.

OBJECTIVE: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019(COVID-19) who developed bowel perforation. MATERIALS AND METHODS: This case series was conducted in Emergency Department of AORN Sant'Anna and S. Sebastiano located in Caserta. All patients resulted positive to SARS-Cov-2 in nasopharyngeal swabs whith a positive laboratory test for SARS-CoV-2 from real time reverse transcription polymerase chain reaction(RT-PCR) as well as bowel perforation which was identified by abdominal CT, from September 2020 to December 2020. RESULTS: A total of five patients were identified with Bowel perforation occurred despite all patients being on anticoagulation. All patients were Italian, predominantly male(four patients) with an average age of 60 years and the most common comorbidity was hypertension, diabetes and obesity. DISCUSSION: Bowel perforation in COVID-19 is clinically significant with high morbidity and mortality. In our series 40% of patients who were diagnosed of bowel perforation died. Average time to death after bowel perforation diagnosis was 6 days. CONCLUSION: We describe a case series of COVID-19 patients who developed bowel perforation. KEY WORDS: Covid-19, Bowel perforation.

[Preservative surgery of the kidney for haemorrhagic angiomyolipoma: a report of two cases]. / Chirurgia conservativa del parenchima renale per angiomiolipoma emorragico: due casi clinici.

Renal angiomyolipomas are very rare benign tumours (3% of renal tumours) that may present as isolated tumours or tumours associated with other pathologies, particularly tuberous sclerosis (40%), neurofibro-matosis, or Sturge-Webers disease. Clinically, renal angiomyolipoma is asymptomatic until the tumour becomes larger than 4 cm, causing urinary symptoms such as pain, infection, and microhaematuria. Rarely, in cases of large hypervascularised lesions, the clinical picture at onset may consist in spontaneous haemorrhage due to vessel rupture. The therapy consists in non-operative treatments for small tumours (< 4 cm) and surgical treatment, probably preservative, for larger tumours. In complicated haemorrhagic cases, an angiographic approach or surgical treatments, possibly conservative, are possible, offering the opportunity for further elective treatment. On the basis of case reports starting with haemorrhage and treated in urgency and of a review of the literature, we conclude that it is possible and mandatory to perform emergency preservative treatments of the kidney with an angiographic or surgical approach, and to ensure haemostasis. Treatment of the disease can be postponed when clinical and environmental conditions are better. Furthermore, we stress the need, once the clinical urgency/emergency is over, to submit the patient to suitable examinations to detect possible associated pathologies (tuberous sclerosis, neurofibromatosis, Sturge-Webers disease) in other parts of the body.

[Treatment of splenic trauma in paediatric age]. / Trattamento del trauma splenico in età pediatrica vs età adulta. Nostra esperienza.

The splenic trauma in children presents some peculiarity that differentiates it from that one in adult age. Therefore we have see again our relative experience on splenic trauma, in the period 2001-2006, confronting two groups of patients, one of inferior age to fourteen years (A Group) and one of advanced age (B Group). We have estimated the following parameters: aetiology, type of lesion, association with others trauma, type of treatment, compliance, mortality, number of transfusions and hospital stay. On a total of 75 splenic trauma (M:52, F:23 of age comprised between 5 and 71 years) 18 belongs to the A group (medium age of 9.2 years) and 57 to the B group (medium ages of 47.4 years). The prevailing aetiology in the A group is domestic accident (39%) and the fall from bicycle (33%), while in the B group it is the street accident (69%). The lesions found in pediatric age are of smaller gravity if compared with B group, for lesion gravity and for association with abdominal and/or extra-abdominal others trauma. In the children group we have performed nonoperative management or conservative surgery in the 83% of cases versus the 26% in the B group. The rate of conversion from a nonoperative treatment in to an operative treatment has been of 7%. The post-operative complicance are absent in the A group and of 5.5% in the B group. The mortality rate in the surgical patients has been of the 14.3% for serious toraco-abdominal trauma in A group and of 11.1% in B group. No mortality is detected in the groups with nonoperative treatment. The medium number of transfusions is of 1.8 units in the paediatric patients and of 2.5 units in the adults. The medium stay in hospital is of eighteen days in the A group and of thirteen days in the B group. In conclusion the marked difference in the two groups examines stays in the type of treatment, more often nonoperative or conservative in the children group.