Emergency Surgery during COVID-19: Lessons Learned

Abstract Introduction The ongoing coronavirus disease-2019 (COVID-19) pandemic has disrupted health services throughout the world. It has brought in several new challenges to deal with surgical emergencies. Herein, we report two suspected cases of COVID-19 that were operated during this “lockdown” period and highlight the protocols we followed and lessons we learned from this situation. Result Two patients from “red zones” for COVID-19 pandemic presented with acute abdomen, one a 64-year male, who presented with perforation peritonitis and another, a 57-year male with acute intestinal obstruction due to sigmoid volvulus. They also had associated COVID-19 symptoms. COVID-19 test could not be done at the time of their presentation to the hospital. Patients underwent emergency exploratory laparotomy assuming them to be positive for the infection. Surgical team was donned with full coverall personal protective equipment. Sudden and uncontrolled egression intraperitoneal free gas was avoided, Echelon flex 60 staplers were used to resect the volvulus without allowing the gas from the volvulus to escape; mesocolon was divided using vascular reload of the stapler, no electrosurgical devices were used to avoid the aerosolization of viral particles. Colostomy was done in both the patients. Both the patients turned out to be negative for COVID-19 subsequently and discharged from hospital in stable condition. Conclusion Surgeons need to adapt to safely execute emergency surgical procedures during this period of COVID-19 pandemic. Preparedness is of paramount importance. Full precautionary measures should be taken when dealing with any suspected case.

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Prospective study of 50 cases of perforative peritonitis a single centre experience

International Surgery Journal ◽

10.18203/2349-2902.isj20173418 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2782

Author(s):

Prakash B. Patel ◽

Suryadeep Baria

Keyword(s):

Prospective Study ◽

Exploratory Laparotomy ◽

Medical College ◽

Primary Peritonitis ◽

Surgical Emergencies ◽

Perforative Peritonitis ◽

Common Etiology ◽

Perforation Peritonitis ◽

A Prospective Study ◽

Surgical Treatments

Background: Perforative peritonitis are most common surgical emergencies seen worldwide. Despite improvement in diagnosis, antibiotics, surgical treatments and intensive care support, it is still an important cause of mortality in surgical patients. This study was done to know the spectrum of etiology, clinical presentation, management and treatment outcomes of patients admitted with perforation peritonitis in our hospital.Methods: A prospective study was done over a period of 3 years from January 2007 to December 2010 in NHL Medical College and V.S. hospital, Ahmedabad which included 50 patients diagnosed with perforation peritonitis. All patients admitted with perforation of gastrointestinal tract were included in this study. All cases of primary peritonitis and anastomotic leaks were excluded from this study.Results: Total 50 cases were included with 80% being males. Highest incidence of perforation peritonitis was noted in 21-30 years of age group in the present study. Most common etiology of perforative peritonitis was noted in the present study was peptic perforation 40% (20) cases, abdominal pain, tenderness were present in all of the perforative peritonitis patients.Conclusions: Perforative peritonitis is more common in male and most common pathology was peptic perforation due to acid peptic disease, in most of the cases after adequate resuscitation and stabilization of the patient Exploratory laparotomy is mainstay treatment modality

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Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

The American Surgeon ◽

10.1177/000313481307901114 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1140-1141 ◽

Cited By ~ 4

Author(s):

Ann A. Albert ◽

Tracy L. Nolan ◽

Bryan C. Weidner

Keyword(s):

Abdominal Pain ◽

African American Male ◽

Pediatric Patients ◽

Primary Anastomosis ◽

Exploratory Laparotomy ◽

Sigmoid Volvulus ◽

Sudden Onset ◽

Contrast Enema ◽

Pediatric Age Group ◽

History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

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Amoebic liver abscess in a COVID-19 patient: a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06819-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Andrea L. Maricuto ◽

Viledy L. Velásquez ◽

Jacinto Pineda ◽

David M. Flora-Noda ◽

Isaac Rodríguez ◽

...

Keyword(s):

Liver Abscess ◽

Abdominal Cavity ◽

Exploratory Laparotomy ◽

Abdominal Ultrasound ◽

Amoebic Liver Abscess ◽

Stool Examination ◽

Nasopharyngeal Swab ◽

Suspected Case ◽

Middle Income ◽

Patient Reported

Abstract Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

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Mannheim Peritonitis Index (Mpi) Score as A Predictor of Outcome in Patients with Secondary Peritonitis

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v4i2.19083 ◽

2018 ◽

Vol 4 (2) ◽

pp. 6-9

Author(s):

Pravin Joshi ◽

Rajesh Poudel ◽

Kailash Chandra

Keyword(s):

Retrospective Study ◽

Scoring Systems ◽

Age Group ◽

Medical Sciences ◽

Mannheim Peritonitis Index ◽

Bacterial Peritonitis ◽

Post Operative Period ◽

Surgical Emergencies ◽

Perforation Peritonitis ◽

The Common

INTRODUCTION: Secondary bacterial peritonitis from hollow viscous perforation is one of the common surgical emergencies and carries higher mortality. Several scoring systems are applied to predict the outcome of patients with perforation peritonitis. Mannheim Peritonitis Index (MPI) is one among many. Our aim of the study is to evaluate Mannheim peritonitis Index for predicting the outcome in patient with secondary bacterial peritonitis. MATERIALS AND METHODS: A retrospective study was conducted in the Department of General Surgery, Universal College of Medical Sciences, Bhairahawa from February 2012 to July 2013. All patients clinically diagnosed as peritonitis and who underwent laparotomy were included in the study. MPI score of all the study patients were calculated and categorized into three groups depending upon the score; less than 15, 15-25 and more than 25. Mortality of patients from each group was calculated and predictive value of each factor was determined. RESULTS: Total 60 patients were included in the study. Forty-four were male and sixteen were female. There were total five mortalities. All were of above 50 years age group. Patients beyond 50 years of age had a significantly higher (p = .005) probability of dying in the early post-operative period. MPI score more than 15 was not statistically significant (p = .06), patients with MPI more than 25 had more probability of dying, hazard ratio (HR 3.4 with 95% CI).Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14, page: 6-9

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Analysing prognostic factors among patients with perforative peritonitis

International Surgery Journal ◽

10.18203/2349-2902.isj20211809 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1466

Author(s):

Pradeep M. Wagh ◽

Samadhan Patil

Keyword(s):

Prognostic Factors ◽

High Mortality ◽

Exploratory Laparotomy ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Perforative Peritonitis ◽

Perforation Peritonitis ◽

Large Perforation

Background: The mortality of perforation peritonitis is highly dependent on early approach to the hospital, quick diagnosis and prompt surgical treatment as it correlates with the duration and degree of peritoneal contamination, the patient's age, the general health of the patient and the nature of the underlying aetiology. The present study was done to assess the role of various prognostic factors which have a bearing on the final outcome of the patients.Methods: This prospective observational cross-sectional study was conducted in the at a tertiary level hospital in Maharashtra, in which 47 patients who presented a surgical emergency of perforation peritonitis and underwent an exploratory laparotomy were included. We compared different variables between patients who survived and those who died. Results: High mortality was also found in patients who presented after 24 hours of developing symptoms. Ileal perforation was significantly more common among dead patients (50%) as compared to patients who survived (20%), p-value<0.05. There were significantly higher proportion of patients who had shock on day 1 who died (67%) as compared to those who survived (12%), p-value<0.05. Also, the group of patients who died, had significantly higher MPI (p-value<0.01), higher proportion of patients with multiple perforations (p-value<0.05), larger perforations (p-value<0.01) and contamination more than 1000 ml (p-value<0.05). Conclusions: High mortality was observed in patients who presented late, had ileal perforations, multiple and large perforation and developed shock on day one.

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A study the profile of pathological disorders resulting in acute abdominal non-traumatic surgical emergencies in a tertiary care hospital, North India

International Surgery Journal ◽

10.18203/2349-2902.isj20180363 ◽

2018 ◽

Vol 5 (2) ◽

pp. 614

Author(s):

Mohamamd Zahid ◽

Mohd Arshad Raza ◽

Manjul Mohan ◽

Ranjan Agrawal ◽

Pramod Kumar

Keyword(s):

Tertiary Care ◽

Exploratory Laparotomy ◽

Sudden Onset ◽

North India ◽

Patch Repair ◽

Treatment Modalities ◽

Care Hospital ◽

Surgical Emergencies ◽

High Index Of Suspicion ◽

Surgery Department

Background: Acute abdomen has a sudden onset, can persist for several hours to days and is associated with wide variety of clinical features requiring evaluation and treatment. The present study has been done to establish the etiopathological details and diagnostic verification of the patients presenting with non-traumatic pain in abdomen. Also, the management and admitted care of non-traumatic abdominal surgical emergencies and their outcome has been discussed.Methods: A prospective observational study was done in Rohilkhand Medical College and Hospital (RMCH) during November 2015 to October 2016. The study includes acute abdominal non-traumatic surgical emergencies presenting in general surgery department. All the data were analyzed through SPSS 22.Results: A total of 182 patients were included in the study. The most common complaint among patients was pain in abdomen followed by constipation and vomiting. The most common cases were intestinal perforation (57%) followed by acute appendicitis (14.89%), acute pancreatitis (9.34%), acute intestinal obstruction (9.34%) and others. Most common treatment modalities applied were Exploratory Laparotomy with true Graham’s patch repair (30.22%), non-operative/conservative treatment (26.92%) and Exploratory Laparotomy with ileostomy (13.19%). Total 13 cases (7.14%) expired (all post-operatively) and 8 cases (4.39%) developed major complications.Conclusions: The clinical course and outcome of acute abdominal emergencies in present study showed that a judicious and careful use of clinical evaluation with high index of suspicion along with radiological and biochemical findings help to reach a diagnosis based on which the appropriate management strategy ensures good outcome.

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Effect of Early Surgery on Outcome In Perforation Peritonitis

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v5i1.19048 ◽

2018 ◽

Vol 5 (1) ◽

pp. 12-16

Author(s):

Tika Ram Bhandari ◽

Rajesh Poudel ◽

Kailash Chandra

Keyword(s):

Length Of Hospital Stay ◽

Postoperative Outcome ◽

Exploratory Laparotomy ◽

Normal Diet ◽

Early Surgery ◽

Medical Sciences ◽

Late Intervention ◽

Perforation Peritonitis ◽

Independent Risk Factors ◽

Early Surgical Intervention

BACKGROUND: Early diagnosis and emergent surgical management of perforation peritonitis remain the mainstay of treatment. The aim of study was to find the effect of early surgery on postoperative outcome in patients with perforation peritonitis.MATERIALS & METHODS: A retrospective medical report of 200 patients who underwent exploratory laparotomy and proceed for perforation peritonitis from July 2015 to December 2016 was studied. Patients were divided into two groups based on the time of surgery i.e: Early (<6 hours) and late (≥6 hours) intervention groups. All perioperative outcome of surgery were analyzed.RESULTS: Late intervention patients were more likely to develop complications (34.3 and 17.8%, P < 0.05) and mortality (14 and 6%, P<0.05) in comparison to early intervention patients and had significantly higher median time to resumption of normal diet (5and 2.8 days, length of hospital stay (15 and 9 days) and length of ICU stay (8 and 4 days) (P < 0.05). The time to operation (≥ 6 hours) and preoperative hypotension were independent risk factors for postoperative complications in multivariate analysis.CONCLUSION: Early surgical intervention within six hours along with broad spectrum antibiotics preceded by adequate aggressive resuscitation improves postoperative outcomes in perforation peritonitis.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, page: 12-16

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Flood loss reduction of private households due to building precautionary measures – lessons learned from the Elbe flood in August 2002

Natural Hazards and Earth System Science ◽

10.5194/nhess-5-117-2005 ◽

2005 ◽

Vol 5 (1) ◽

pp. 117-126 ◽

Cited By ~ 229

Author(s):

H. Kreibich ◽

A. H. Thieken ◽

Th. Petrow ◽

M. Müller ◽

B. Merz

Keyword(s):

Financial Incentives ◽

Flood Damage ◽

Lessons Learned ◽

Information Campaigns ◽

Private Households ◽

River Elbe ◽

Extreme Flood ◽

Flood Loss ◽

Prone Area ◽

Precautionary Measures

Abstract. Building houses in inundation areas is always a risk, since absolute flood protection is impossible. Where settlements already exist, flood damage must be kept as small as possible. Suitable means are precautionary measures such as elevated building configuration or flood adapted use. However, data about the effects of such measures are rare, and consequently, the efficiency of different precautionary measures is unclear. To improve the knowledge about efficient precautionary measures, approximately 1200 private households, which were affected by the 2002 flood at the river Elbe and its tributaries, were interviewed about the flood damage of their buildings and contents as well as about their precautionary measures. The affected households had little flood experience, i.e. only 15% had experienced a flood before. 59% of the households stated that they did not know, that they live in a flood prone area. Thus, people were not well prepared, e.g. just 11% had used and furnished their house in a flood adapted way and only 6% had a flood adapted building structure. Building precautionary measures are mainly effective in areas with frequent small floods. But also during the extreme flood event in 2002 building measures reduced the flood loss. From the six different building precautionary measures under study, flood adapted use and adapted interior fitting were the most effective ones. They reduced the damage ratio for buildings by 46% and 53%, respectively. The damage ratio for contents was reduced by 48% due to flood adapted use and by 53% due to flood adapted interior fitting. The 2002 flood motivated a relatively large number of people to implement private precautionary measures, but still much more could be done. Hence, to further reduce flood losses, people's motivation to invest in precaution should be improved. More information campaigns and financial incentives should be issued to encourage precautionary measures.

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SPECTRUM OF PERFORATION PERITONITIS IN WESTERN NEPAL

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v6i1.21663 ◽

2018 ◽

Vol 6 (1) ◽

pp. 11-13

Author(s):

Rajesh Poudel ◽

Santosh Shah ◽

Kailash Chandra ◽

Saroj Pradhan ◽

Pravin Joshi

Keyword(s):

Indian Subcontinent ◽

Care Center ◽

Tertiary Care ◽

Exploratory Laparotomy ◽

Medical Sciences ◽

Peptic Disease ◽

Perforation Peritonitis ◽

One Year ◽

Operative Findings ◽

Perforated Peritonitis

Introduction: Despite advances in surgical technique, antimicrobial therapy and perioperative care morbidity and mortality in perforated peritonitis is still high. Aim of this study was to highlight the clinical presentation, intra operative findings and postoperative complications and mortality among patient who has undergone emergency surgery for perforated peritonitis in tertiary care center in western Nepal.Materials and Methods: This was a retrospective descriptive study carried out in Universal College of Medical Sciences, Bhairawha, Nepal. All patients who underwent emergency exploratory laparotomy for perforated peritonitis in one year period (from April 2014 to March 2015) were included in the study.Results: Total 90 cases met inclusion criteria and were analyzed. Most common presenting symptom was pain abdomen. Pneumoperitoneum was seen in 86 (95.6%) patients. Most common site of perforation was prepyloric perforation followed by duodenum. Most common cause of perforation was Acid peptic disease. Most common surgical procedure performed was Omentopexy. There were total of 11 (12.2%)mortality.Conclusion: The spectrum of perforation peritonitis in our study differs from western countries whereas it is similar to that of other research from Indian subcontinent. Majority of perforations are noticed in the duodenum and stomach due to acid-peptic disease and small bowel typhoid followed by trauma. Overall mortality was seen in 12.2%.Journal of Universal College of Medical ScienceVol. 6, No. 1, 2018, Page: 11-13

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A Suspected Case Of Endoscopic Ultrasound Induced Pancreatitis, Without Fine Needle Aspirate

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v10i4.92 ◽

2016 ◽

Vol 10 (4) ◽

Author(s):

Michael John Abunassar BSc, BA, MD ◽

Loree Boyle, BN, MD, FRCPC ◽

Avijit Chaterjee, MSc, MDCM. FRCPC

Keyword(s):

Acute Pancreatitis ◽

Endoscopic Ultrasound ◽

Pancreatic Cyst ◽

Epigastric Pain ◽

Stable Condition ◽

Suspected Case ◽

Fine Needle Aspirate ◽

Recurrent Pancreatitis ◽

Fine Needle ◽

History Of

A 78-year-old male developed nausea and epigastric pain 8 hours following an endoscopic ultrasound (EUS) procedure. The patient had a history of recurrent pancreatitis, and underwent the EUS procedure with the aim of aspirating a pancreatic cyst. The cyst had regressed in size, in keeping with a pseuodocyst, and was not biopsied. The patient tolerated the procedure well with no immediate complications, and was discharged home in stable condition. Eight hours later, the patient developed acute pancreatitis.

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