Acute diverticulitis in COVID-19 patients: parallel management in three cases. Are the guidelines adapting? = Diverticulite aguda em pacientes com COVID-19: manejo paralelo em três casos. As diretrizes estão se adaptando?

Introduction: One concern in COVID-19 era is to treat surgical cases. According to the literature, a positive Sars-CoV-2 swab should delay surgery. The decision-making process is more challenging in cases of emergency. This report aims to present the management of acute diverticulitis in COVID patients. Case report: Three cases of perforated diverticulitis in COVID patients occurred in our institution. Two cases, whose one was symptomatic for COVID, underwent a Hartmann procedure. In the third case, a percutaneous drainage was performed, because of age and comorbidities. No complications occurred. A perianal swab and a drainage fluid swab were collected. The rRT-PCR analysis was negative for Sars-CoV-2. The decision-making process in cases of emergency surgery during a SarsCoV-2 infection is challenging. It is demonstrated that a positive Sars-CoV-2 swab should delay surgery, but we need evidence on the management of COVID-19 surgical patients during emergencies. We tried conservative solutions and avoided excessive exposition of the personnel. When pulmonary and general conditions allowed a surgical approach, we performed it. We did not find any viral presence in our patients’ body fluids and gastrointestinal samples. On the other hand, some authors reported the presence of the virus in feces specimens and anal swab tests. These contradictory findings are yet to be confirmed. Conclusion: The management of surgical emergencies in COVID-19 patients is challenging. The present work aims to give a contribution to the management of such surgical emergencies, as well as to warn colorectal surgeons about possible challenges.