Outcomes of Patients With Acute Limb Ischemia in Patients With COVID-19: A Systemic Review and Meta-Analysis.

A systemic review and meta-analysis of perioperative outcomes of acute limb ischemia (ALI) in patients with and without coronavirus disease-2019 (COVID-19) to determine the outcomes of ALI and compare the outcomes in patients with and without COVID-19 infection. A literature search of the Medline, Science Direct and Cochrane Library was performed from inception to July 15, 2021. Studies involving ALI in patients with COVID-19 were searched through three electronic databases. The endpoints include limb salvage, re-thrombosis, and mortality, and these outcomes were compared between patients with and without COVID-19 infection and type of management. The primary outcome was early limb salvage (till the patient was discharged from the hospital). The other outcomes assessed were re-thrombosis and mortality. These outcomes were compared between patients with and without COVID-19 infection and the type of management. Pooled estimates were presented as odds ratios (ORs) using a random or fixed effect model based on the results of the chi-square test and calculation of I2. Comparing the ALI outcomes in patients with and without COVID-19 infection, there was no significant difference in limb salvage rate (OR=0.26, 95% CI:0.02-3.09), but there was a significantly higher re-thrombosis (OR=2.65, 95% CI:1.34-5.23) and mortality rate (OR=4.71, 95% CI:1.11-19.99) in patients with COVID-19 infection. On comparing outcomes based on management, intervention group, and anticoagulant alone group, no significant difference was noted concerning limb salvage (OR=1.40, 95% CI:0.27-7.13) and mortality rates (OR=0.2, 95% CI:0.04-1.07). This meta-analysis demonstrates a higher re-thrombosis and mortality in ALI patients with COVID-19 infection when compared to patients without COVID-19 but with similar limb salvage.

Inadvertent Bowel Injury Following Repeated Suprapubic Catheterisation in a Patient of Post-Pelvic Radiotherapy.

Suprapubic catheterization (SPC) is one of the standard procedures in urological emergencies. The common complications of SPC include loss of track, hematuria, catheter blockage, and catheter-related infections. However, severe complications like bowel injuries, including intestinal obstructionand perforation, can also occur. We present the case of a 54-year-old lady who had received pelvic radiation 30 years ago for carcinoma cervix. She presented to a secondary-level care center with anuria. On failure of per urethral catheterization, she repeatedly underwent unguided SPC. However, unsatisfied with her recovery, she was brought to our tertiary care center by her relatives. She was found to have inadvertent placement of SPC in the small bowel, which was confirmed preoperatively by ultrasound and CT. Intraoperatively, the SPC catheter was seen inside the terminal ileum causing ileal wall necrosis and a localized feco-purulent collection. Urinary bladder rent was also noted at the site of the earlier SPC. Resection of distal ileum with double barrel ileostomy, followed by primary repair of the bladder wall, was done. Unfortunately, she succumbed to overwhelming sepsis and expired in the postoperative period. This case emphasizes a potential higher risk of life-threatening bowel injury due to SPC insertion in patients with previous pelvic irradiation. Such high-risk cases should be approached with the utmost care, preferably under ultrasound guidance. For safe practice, the British Association of Urological Surgeons' guidelines for SPC insertion should be followed.