Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis.

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people's willingness to seek medical care and the subsequent effects on patients' prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23-May 4, 2020-COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.

[Primary lymphoma of the rectum: a case report and review of the literature]. / Il linfoma primitivo del retto. Presentazione di un caso e revisione della letteratura.

A case of primary malignant lymphoma of the rectum is presented and the literature reviewed. The authors recommend a complete diagnostic evaluation to assess the unifocal nature of the tumour and stage it, as well as in order to exclude systemic disease. Surgical therapy combined with chemo- and radiotherapy is the best choice when the disease is confined to the rectum, with a better prognosis than those cases treated by chemo- and radiotherapy alone. Because of the extreme rarity of the disease it is impossible to find randomised studies and any evaluation of prognosis can only be done on the basis of the small case series reported in the literature.