Surgical intervention for acute pancreatitis in the COVID-19 era

Approximately 15%-19%of patients with severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)infections develop gastrointestinal symptoms.Acute pancreatitis(AP)has been reported in 0.1%of patients with coronavirus disease 2019(COVID-19).Biliary AP was most common(78.4%)before the COVID-19 pandemic;idiopathic AP is most common in patients with COVID-19(up to 57.1%).The number of emergency department presentations decreased by 23.3%during the pandemic and many governments made national recommendations to delay nonurgent endoscopic procedures,leading to decrements of 22%in combined esophagogastroduodenoscopy(EGD)and colonoscopy and 20%in EGD after the COVID-19 pandemic.The symptoms and signs of COVID-19-related AP are fever(63%),abdominal pain(58%),respiratory symptoms(40%),nausea and vomiting(39%),and headache(4%).Approximately 5-10%of patients develop necrotizing or hemorrhagic AP,and patients who required surgical intervention had a higher mortality risk.Compared to 2019,the rates of elective surgery decreased by 41.8%in 2020;including cholecystectomy(40.1%decrease)and pancreas(111.1%decrease).Surgical volumes also decreased by 18.7%in 2020;device-assisted laparoscopic and robot-assisted procedures reduced by 45.4%and 61.9%during the COVID-19 Lockdown in 2020.

Intracranial hemorrhagic embolus

A febrile and unconscious man was sent to our emergency department. On physical examinations, some dark red ecchymosis/discoloration over the trunk and track mark in the left-sided groin region were seen. Brain CT scan showed septic emboli complicated with hemorrhage. Chest X-ray revealed pulmonary emboli. Aortic valve vegetation was found by echocardiography. Although aggressive treatment and resuscitation were taken, he died of methicillin-sensitiveStaphylococcus aureus sepsis and multiple organ failure. Intravenous drug users are susceptible to right-sided infective endocarditis. In our case, left-sided infective endocarditis with lung and brain embolism resulting in fatality was relatively uncommon. Review of literature was also made for this article.

Impact of COVID-19 on liver

The incidence of liver injury after coronavirus disease 2019(COVID-19)infection ranged from 15%-53%.The mechanism includes direct viral cytopathic effect,cytokinesis,and treatment drug-induced liver injury.The symptoms include nausea,vomiting,diarrhea,and loss of appetite.The laboratory results include increased liver enzyme levels,decreased monocyte count,and longer prothrombin time.The most common imaging findings are hepatomegaly on ultrasound,ground-glass opacity on chest computed tomography(CT),and liver hypodensity and pericholecystic fat stranding on abdominal CT.Patients may also have different presentations and poor outcomes of different liver diseases concomitant with COVID-19 infection.Liver function test(LFT)results should be monitored,and all factors known to cause or predispose liver injury should be investigated while managing the patients.The risks of transfer to an intensive care unit,need for mechanical ventilator support,and acute kidney injury is higher in COVID-19 patients with than without abnormal LFTs.Increased mortality and length of hospital stay are both observed.