Int J Surg Case Rep . Rapidly Fatal Outcome of Covid-19 After Successful Emergency Surgery During Pandemic Outbreak in Northern Italy

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Int J Surg Case Rep


. 2020 Jun 20;73:9-12.
doi: 10.1016/j.ijscr.2020.06.073. Online ahead of print.
Rapidly Fatal Outcome of Covid-19 After Successful Emergency Surgery During Pandemic Outbreak in Northern Italy


Filippo Montali ¹ , Gerardo Palmieri ² , Lorenzo Casali ² , Lorenzo Pagliai ² , Renato Costi ³



Affiliations

• PMID: 32622186
• DOI: 10.1016/j.ijscr.2020.06.073

Abstract

Introduction: A pandemic outbreak of novel coronavirus, named SARS-CoV-2 and responsible of Coronavirus Disease 2019 (COVID-19), has rapidly spread from China to Europe, being Northern Italy the first focus outside Asia. Little is known about the evolution of SARS-CoV-2 infection in patients undergoing surgery.
Presentation of case: Here we report the first confirmed case of early postoperative SARS-CoV-2 infection in a patient recovering after Hartmann's procedure for acute diverticulitis. After an otherwise unevenful postoperative course, on post-operative day 8, the patient suddenly presented hyperpyrexia and cough, rapidly evolving to respiratory failure and death 36 h after symptoms onset. CT-scan identified bilateral, diffuse, interstitial pneumonitis and oropharyngeal swab test confirmed the presence of SARS-CoV-2. A previous contact with the partner, developing the same symptoms, remained unrecognized until ICU admission.
Discussion: During a pandemic outbreak, the early identification of SARS-CoV-2 infection of an inside patient initially considered to be infection-free has a pivotal importance not only for the prompt patient's management, but also to avoid infection spreading to other patients and hospital personnel.In the reported case, a more precise information to the patient regarding the imperative necessity to inform the medical personnel of any person of his entourage presenting, at any time, any tell-tale sign, symptom or examination which may be attributed to COVID-19, may have had allowed to anticipate patient's isolation and examinations and procedures aimed at identifying such an infection.
Conclusion: Persistent hyperleucocytosis and increased CRP serum level in spite of uneventful postoperative course were the only, aspecific markers of an ongoing SARS-CoV-2 infection before symptoms' onset, and should be considered in future clinical practice in order to adopt the prompt and appropriate patient management and limit COVID-19 contagion in surgical units.

Keywords: COVID-19; Emergency surgery; Fatal outcome; Pandemic outbreak; SARS CoV-2.