Colorectal emergency surgery in a COVID-19 referral hospital during the phase 2 in Italy
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LETTER TO THE EDITOR
Colorectal emergency surgery in a COVID-19 referral hospital during the phase 2 in Italy Giorgio Lisi 1
&
M. Campanelli 2 & M. Villa 3 & S. Grande 3 & M. Grande 3
Accepted: 25 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor: The outbreak of SARS-CoV-2 infection, first reported in China in December 2019, has become a public health emergency of international concern that also affects patients with colorectal disease [1]. Recently, the University Hospital of Rome Tor Vergata was named “Covid Hospital-4,” the fourth referral center in Rome for COVID-19-positive patients. As a result, all surgical services across the department, with the exception of the endoscopic session for oncological and urgent cases, were locked with the result that the vast majority of surgeons operated only in urgent cases (73.9%) [2], but the number of interventions significantly dropped. In the past 2 weeks, the Italian government has declared “phase 2” of the lockdown reducing restrictions and access to hospitals as well as outpatient. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment [2]. We share some considerations about our first 2 weeks of colorectal emergency surgery during phase 2, with particular attention to the increase number of complex colorectal emergency cases. We reported 11 difficult cases of emergency colorectal surgery in contrast to the same period before and during the lockdown: 4 cases of Hinchey III and IV diverticulitis, 3 locally advanced colorectal cancers with intestinal obstruction, and four obstructive right colon cancer. According to the recent survey by Patriti et al. sent to 150 Italian heads of General Surgery [2], about 40% of surgeons reported an unusual delay in the presentation of non-traumatic
* Giorgio Lisi [email protected] 1
University Hospital of Tor Vergata, viale Oxford 81, 00133 Rome, Italy
2
Mininvasive Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133 Rome, Italy
3
Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133 Rome, Italy
abdominal emergencies. In all cases, the fever had been present for several days before hospitalization. The delay was partially related to patient choice, preferring to stay at home until symptoms worsened, and in part due to the waiting list for the COVID-19 emergency room test, almost half of the centers reported emergency associated with a more serious presentation due to a diagnostic delay. In our country, many patients with fever have asked the authorities not to go to the hospital if they do not have breathing difficulties. In these patients, fever may not be caused by COVID-19-related pneumonia but by an abdominal infection. There are also numerous patients whose diagnostic delay is related to the time spent in the emergency room, both because of the scarcity of hospital beds available and because of the diagnostic work for COVID-19. Our preliminary experience recognizes some of the main reasons for
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