Covid-19 mimicking symptoms in emergency gastrointestinal surgery cases during pandemic: A case series

BACKGROUND: The COVID-19 pandemic has changed patient management in all sectors. All patients need
to be examined for COVID-19, including in digestive surgery emergency cases. In this paper, we report
four digestive surgery emergency cases with clinical and radiological findings similar to COVID-19.
CASE PRESENTATION: We report four digestive surgery emergency cases admitted with fever and cough
symptoms. Case 1 is a 75-year-old male with gastric perforation and pneumonia, case 2 is a 32-year-old
female with intestinal and pulmonal tuberculosis, case 3 is a 30-year-old female with acute pancreatitis
with pleuritis and pleural effusion, and the last case is a 56-year-old female with rectosigmoid cancer with
pulmonal metastases. All the patients underwent emergency laparotomy, were hospitalized for therapy,
and discharged from the hospital. After 1-month follow-up after surgery, 1 patient had no complaints, 2
patients had surgical site infection, and 1 patient died because of ARDS due to lung metastases.
DISCUSSION: For all four cases, the surgeries were done with strict COVID-19 protocol which included
patient screening, examination, laboratory assessment, rapid test screening, and RT-PCR testing. There
were no intrahospital mortalities and all the patients were discharged from the hospital. Three patients
were followed-up and recovered well with 2 patients having surgical site infection which recovered
within a week. However, 1 patient did not show up for the scheduled follow-up and was reported dead
2 weeks after surgery because of ARDS due to lung metastases.
CONCLUSIONS: Emergency surgery, especially digestive surgery cases, can be done in the COVID-19
pandemic era with strict prior screening and examination, and safety protocol.