Gastric Perforation as a Complication of COVID-19 Infection: A Case Report.

Pulmonary symptoms are the primary manifestation of the COVID-19 disease, which originated in Wuhan in China in December 2019. However, it is now established to show widespread extrapulmonary manifestations, including gastrointestinal involvement. Abdominal pain, diarrhea, nausea, and vomiting are considered the most common gastrointestinal symptoms. Gastric perforation in association with COVID-19 is rarely reported in the literature. Here, we report a case of a 71-year-old male COVID-19-infected patient, medically free, who presented to the emergency department complaining of severe abdominal pain for a one-week duration. He was diagnosed with a case of perforated viscus and septic shock. The patient was shifted to the operating room for exploratory laparotomy. We aim in this report to highlight this fatal complication of COVID-19 infection in order to improve patients' outcomes.

Prophylactic prosthetic wrapping for vascular anastomosis in patients with Behçet's aortic aneurysms: an experience from a resource-challenged setting.

BACKGROUND: The objectives of the current study were to evaluate our technical and clinical results of surgical treatment of infrarenal Behçet's abdominal aortic aneurysm (AAA). In addition to the prosthetic wrapping of the constructed anastomosis as a prophylactic measure for patients with vasculo-Behçet's disease, together with the administration of per- and postoperative immunosuppressive therapy. METHODS: A single-center retrospective case series included 16 patients with vasculo-Behçet's AAA who treated with open surgical repair, between January 2005 and December 2013. The administration of immunosuppressive treatment was done preoperatively to achieve complete remission of the disease activity before starting the surgical repair. Patients' data were retrieved and analyzed emphasizing the diagnostic procedures, the used surgical techniques, and suitable graft selection, as well as, graft-related complications. The patients were followed up for one month to a maximum of 72 months. The median follow-up period was 24.83±9.4 months. RESULTS: This study included 16 patients, 10 (63%) males, and 6 (37%) females, with the median age of (30.50 years, range: 21-37 years). Moreover, all patients were anticoagulated and discharged on warfarin and aspirin therapy. All surgical procedures were done on an elective basis except for only one emergency laparotomy, which was performed for a life-threatening ruptured aneurysm. The vascular anastomoses were performed using either interposition tube graft (for isolated AAA), or Y-shaped graft (for concomitant aorto-iliac aneurysms). Furthermore, prophylactic prosthetic wrapping was applied encircling the graft to the host artery. In addition, all patients received systemic immunosuppressive therapy post-surgical intervention to prevent anastomotic site complications. Technical success was obtained in 100% of cases. Moreover, the patients were followed up for a period of 12-72 months. Two anastomotic pseudoaneurysms were developed postoperatively. More interesting is that both were infected (one low-virulent that was conservatively treated and one overt that was surgically repaired). Furthermore, there was no aneurysm-related mortality. CONCLUSIONS: Prophylactic prosthetic wrapping of vascular anastomosis in patients with Behçet's AAA in resource-challenged settings, where the proximal anastomoses were all end-to-end with wrapping, is an affordable, simple, reliable, and feasible technique, and commonly associated with a lower incidence of anastomotic site false aneurysms and different complications related to the implanted graft, where endovascular procedures might not be applicable. Moreover, the proper preoperative medical preparation for controlling the activity of Behçet's disease, with the administration of immunosuppressive agents, followed by immediate postoperative therapy, may have a good impact on the operative technical success and the prevention of the development of serious postoperative complications; especially anastomotic pseudoaneurysms (which may be complicated by fatal hemorrhage), as well as other graft-related complications.

Examination under anesthesia for management of impalpable undescended testis: a traditional technique revisited.

BACKGROUND: Many new tools for management of impalpable testes have emerged during the last few years, yet, not many studies have compared them to the traditional ways of managing this problem. This work aims to reiterate the importance of the physical examination under general anesthesia prior to the surgical procedure in order to decide the best surgical approach for patients with impalpable undescended testis, especially in developing countries where expensive investigations are at premium. PATIENTS AND METHODS: The study included boys who were treated consecutively and recorded prospectively from 2000 to 2010. Examination under anesthesia (EUA) was performed during the study period. Those in whom the testes were palpable underwent the standard orchiopexy procedure. In those boys where EUA failed to detect the testes, laparoscopy or extended inguinal exploration was carried out, and the testes were treated accordingly. RESULTS: On initial clinical evaluation at the outpatient clinic, 545 boys were recorded to have impalpable testes. Undescended testis was unilateral in 529 boys and bilateral in 16 boys. However, on examination under anesthesia only 189 (34.7 %) were impalpable. Among boys in whom the testes were palpable after EUA, 38 had small-size testes, 18 had normal size, and the remaining 300 boys had a sac or cord-like structure. CONCLUSIONS: Meticulous EUA facilitates the accurate diagnosis and planning of the surgical approach to patients with an impalpable testis and should remain part of the surgeon's skill set. It is an inexpensive initial evaluation tool that may help in saving hospital resources, especially in developing countries.