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.

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? / C. Guerci, G. Goi, A. Maffioli, A. Bondurri, P. Danelli. - In: RELATOS DE CASOS CIRÚRGICOS. - ISSN 2527-2039. - 7:3(2021), pp. e2964.1-e2964.8. [10.30928/2527-2039e-20212964]

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?

Guerci, Claudio;Goi, Gloria;Maffioli, Anna;Bondurri, Andrea;Danelli, Piergiorgio
2021

Abstract

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.
INTRODUÇÃO: Uma preocupação na era COVID-19 é tratar os casos cirúrgicos. A literatura prevê que com um teste positivo a cirurgia seja postergada. O processo de tomada de decisão é mais desafiador em emergência. O presente relato pretende apresentar o manejo de diverticulite em pacientes com COVID. RELATO DO CASO: Três casos de diverticulite perfurada em pacientes com COVID ocorreram em nossa instituição. Dois casos, sendo um deles sintomático para COVID, foram submetidos a procedimento de Hartmann. No terceiro caso, foi realizada drenagem percutânea, devido à idade e às comorbidades. Não ocorreram complicações. Um swab perianal e de fluido de drenagem foram coletados. A análise foi negativa para Sars-CoV-2. O processo de tomada de decisão em casos de cirurgia de emergência durante uma infecção por Sars-CoV-2 é desafiador. É demonstrado que com um teste positivo, a cirurgia seja postergada, mas precisamos de evidências sobre o manejo de pacientes cirúrgicos COVID-19 durante as emergências. Tentamos soluções conservadoras e evitamos a exposição excessiva do pessoal. Quando as condições pulmonares e gerais permitiam uma abordagem cirúrgica, nós a realizávamos. Não encontramos qualquer presença viral no teste de estoma, nem anal. Por outro lado, alguns autores relataram a presença do vírus em fezes e testes de swab anal. Esses achados contraditórios ainda precisam ser confirmados. CONCLUSÃO: O gerenciamento de emergências cirúrgicas em pacientes com COVID-19 é desafiador. O presente trabalho visa contribuir para o manejo dessas emergências cirúrgicas, bem como alertar os cirurgiões colorretais sobre possíveis desafios.
Diverticulite; Cirurgia Colorretal; Infecções por Coronavirus; Diverticulitis. Colorectal Surgery. Coronavirus Infections;
Settore MED/18 - Chirurgia Generale
RELATOS DE CASOS CIRÚRGICOS
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/898773
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