A Unique Presentation of COVID-19 in a Patient Post Sleeve Gastrectomy
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LETTER TO THE EDITOR
A Unique Presentation of COVID-19 in a Patient Post Sleeve Gastrectomy Catharine Taube 1 & Sami Mansour 1 & Sherif Hakky 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
We present a case of a 35-year-old female who presented to the accident and emergency department of our university teaching hospital in London, one of the worst hit cities in Europe with the SARS-CoV-2 pandemic. She complained of a 6-day history of progressive vomiting and epigastric pain culminating in an inability to hold down any fluids. This was on a background of an uneventful laparoscopic sleeve gastrectomy for management of morbid obesity that was performed 6 weeks prior. Additional past medical history includes insulin-dependent type 2 diabetes, hypertension and hypercholesterolemia. The operation was uneventful, and there were no immediate post-operative complications. The patient was discharged on day 2 post-operative. She then attended her routine followup appointment on day 10 where she was found to be in good health with no complaints or symptoms to report. Vital signs and observations were normal, and she was tolerating her liquid diet without vomiting or pain. Abdominal examination was unremarkable, and biochemical tests were all within normal range. Other than her presenting symptoms, she denied any other symptoms, namely, cough, fevers, myalgia and diarrhoea. She had no recent travel history. She lives with her partner and two children who do not report any similar symptoms. She was triaged by the accident and emergency team who accordingly put her to the “green” non-COVID area. She was then referred
to the bariatric team for further management as a bariatric surgical emergency. On examination there was mild abdominal tenderness around the port sites and in the epigastric region. The patient was normotensive, apyrexial and mildly tachycardic at 102 beats per minute with oxygen saturations of 99% on room air. Laboratory tests showed a white cell count of 6.4 × 109/ L, a lymphocyte count of 2.0 × 109/L and a mildly elevated CRP of 39.7 mg/L. Renal function showed no electrolyte disturbance or evidence of dehydration. Likely cause for this presentation was assumed to be a surgical complication, and our working diagnosis was a stricture within the sleeved stomach, a port site hernia or, far less likely, a possible leak. A CT scan of the abdomen with intravenous and oral contrast was performed. The CT (Fig. 1) showed no evidence of surgical complications with free flow of contrast across the sleeved stomach and the small bowel. However, the scanned lung bases showed classic COVID-19 infection changes (Fig. 2). The formal
* Sherif Hakky [email protected] Catharine Taube [email protected] Sami Mansour [email protected] 1
Imperial Weight Centre, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London W2 1NY UK
2
Department of General Surgery, Cairo University, Giza, Egypt
Fig. 1 A CT scan image showing free flow of contrast through the sleeved stomach and into the sma
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