Gastrointestinal perforation in a critically ill patient with COVID-19 pneumonia

Kangas-Dick, Aaron; Prien, Christopher; Rojas, Kristin E.; Pu, Qinghua; Hamshow, Mohammad; Wan, Elias; Chawla, Kabu; Wiesel, Ory

doi:10.1177/2050313x20940570

Cited by 22 publications

(28 citation statements)

References 13 publications

(17 reference statements)

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“…Critically ill ICU patients due to COVID-19 are mostly kept nil orally and can also have stress-related mucosal damage with ulceration. These patients become significantly constipated contributing to increased intraluminal pressure [12] . Colonic dilatation and increase intraluminal pressure can precipitate perforation of the gastrointestinal tract particularly the stomach, duodenum, and colon.…”

Section: Casementioning

confidence: 99%

Gastrointestinal perforation in COVID-19 patients – case series and review of the literature

Verma

Sharma

Garg³

et al. 2020

CSRC

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2) involving the respiratory tract started in 2019 in Wuhan, China but spread to almost all parts of the world to the extent that it was declared a pandemic by WHO. As more and more cases are detected, the involvement of systems other than respiratory was observed and nearly 5 to 50 % of patients have abdominal symptoms like pain and diarrhea. During the course of treatment, few patients developed a rare complication of gastrointestinal perforation. Three cases (two with colonic perforation and one with gastric perforation) of gastrointestinal perforation in COVID-19 positive patient are reported in the article with a review of the literature regarding the various hypothesis of intestinal perforation in these patients. Keywords: COVID-19; gastrointestinal perforation; severe acute respiratory syndrome coronavirus-2 (SARS-CoV 2); Tocilizumab

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Section: Casementioning

confidence: 99%

Gastrointestinal perforation in COVID-19 patients – case series and review of the literature

Verma

Sharma

Garg³

et al. 2020

CSRC

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“…Familiarity with bedside procedures allowed for rapid, safe, and effective performance of interventions in a timely manner. 11 We believe this report to be the only description of the establishment of a general surgery resident-led and -run dedicated COVID-19 unit thus far. The interdisciplinary nature of this care team allowed for sharing of different expertise and perspectives on the management of COVID-19 patients.…”

Section: Discussionmentioning

confidence: 92%

Rapid Adoption of an Interdisciplinary Care Team Model for Surgical Residents Managing Coronavirus Disease-19

Kangas-Dick

Diaz-Siso

Griffiths

et al. 2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction: Patients infected with SARS-Cov-2, the causative virus behind the coronavirus disease-19 (COVID-19) pandemic, have been increasing rapidly in New York City. New York City has the highest incidence in the United States and fully 45% of all deaths from COVID-19. Our medical center is located within a high-density region of cases in south Brooklyn and, in fact, three of our neighborhood zip codes are in the top seven in New York in incidence. As a result, our center has experienced a dramatic increase in hospitalizations, particularly respiratory distress secondary to COVID-19, which rapidly exceeded the capacity of our internal medicine service. This necessitated the formation of new COVID-19 units throughout the hospital, replacing all former service lines. These units employed management teams composed of residents from many medical and surgical disciplines, including general surgery residents. Methods: Our general surgery residency program established a surgical COVID-19 (SCOVID) management team. Initially, 4 surgical residents (2 senior and 2 junior), 1 attending surgeon, and 1 attending internal medicine physician were allocated to the initial SCOVID team. On day 3 of implementation, to achieve more rapid competence in the complex management of these patients, a senior medicine resident with direct experience in the care of COVID-19 patients was added in an advisory capacity. Results: The addition of an experienced senior medical resident and attending allowed for the quick adoption of uniform management protocols by surgical residents and attendings. Discussion: We describe a protocol for the establishment of COVID-19 management teams staffed with general surgical residents, as well as a strategy for the achievement of rapid increases in competency. The addition of a senior internal medicine resident and attending to our SCOVID team allowed for rapid achievement of competency in the care of COVID-19 patients in our large institution at the epicenter of the COVID-19 pandemic.

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“…[ 33 ] This is in line with the previously published cases where all were managed surgically except the one reported by Kangas-Dick et al due to the patient's critical condition, so he was managed conservatively but unfortunately, he died. [ 17 ] However, in selected cases where there are no active signs of peritonitis, abdominal sepsis or having sealed perforation, conservative treatment is an acceptable management strategy. [ 34 , 35 ] This was the case in 2 of our cases who were managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal perforation secondary to COVID-19

Argan¹,

Alqatari²,

Said³

et al. 2021

Medicine

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Introduction: Corona virus disease-2019 (COVID-19) presents primarily with respiratory symptoms. However, extra respiratory manifestations are being frequently recognized including gastrointestinal involvement. The most common gastrointestinal symptoms are nausea, vomiting, diarrhoea and abdominal pain. Gastrointestinal perforation in association with COVID-19 is rarely reported in the literature. Patient concerns and diagnosis: In this series, we are reporting 3 cases with different presentations of gastrointestinal perforation in the setting of COVID-19. Two patients were admitted with critical COVID-19 pneumonia, both required intensive care, intubation and mechanical ventilation. The first one was an elderly gentleman who had difficult weaning from mechanical ventilation and required tracheostomy. During his stay in intensive care unit, he developed Candidemia without clear source. After transfer to the ward, he developed lower gastrointestinal bleeding and found by imaging to have sealed perforated cecal mass with radiological signs of peritonitis. The second one was an obese young gentleman who was found incidentally to have air under diaphragm. Computed tomography showed severe pneumoperitoneum with cecal and gastric wall perforation. The third case was an elderly gentleman who presented with severe COVID-19 pneumonia along with symptoms and signs of acute abdomen who was confirmed by imaging to have sigmoid diverticulitis with perforation and abscess collection. Interventions: The first 2 cases were treated conservatively. The third one was treated surgically. Outcome: Our cases had a variable hospital course but fortunately all were discharged in a good clinical condition. Conclusion: Our aim from this series is to highlight this fatal complication to clinicians in order to enrich our understanding of this pandemic and as a result improve patients’ outcome.

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Gastrointestinal perforation in a critically ill patient with COVID-19 pneumonia

Cited by 22 publications

References 13 publications

Gastrointestinal perforation in COVID-19 patients – case series and review of the literature

Gastrointestinal perforation in COVID-19 patients – case series and review of the literature

Rapid Adoption of an Interdisciplinary Care Team Model for Surgical Residents Managing Coronavirus Disease-19

Gastrointestinal perforation secondary to COVID-19

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