Oof, a new study puts "bowel evisceration" on the growing list of reasons to try like hell not to catch COVID!
Gizmodo recently reported on an article by a team of doctors/researchers from the Department of Surgery, University of Illinois at Chicago, published in the Journal of Gastrointestinal Surgery. The journal article, entitled "Spontaneous Abdominal Evisceration due to COVID-19," details the case of a woman who contracted COVID-19 after previous abdominal surgeries and whose COVID-19-induced cough caused fascial dehiscence (separation of the sutured abdominal wall after surgery) and evisceration (disembowelment). Or, as Gizmodo so bluntly puts it, the patient's "COVID-induced cough caused her guts to spill out from an old surgical site." Gizmodo continues:
Surgeons at the University of Illinois at Chicago wrote about the case, which involved a 52-year old woman. More than a decade earlier, the woman underwent abdominal surgery to treat a hernia. Unfortunately, the hernia continued to cause trouble and she required additional procedures to repair it over the years.
Five days before she visited the hospital, the woman had come down with COVID-19. She experienced repeated episodes of coughing and, after an especially unlucky fit, her bowels burst out of her body through the hernia repair site. By the time she reached the hospital, she was in dire enough straits that she had to be resuscitated. But surgeons were able to carefully push her guts back in where they belonged and close her wound up without major complications . . .
The woman did need several layers of stitches to ensure that her guts would stay put. But she was able to start eating food again within two days of her surgery, and she was released from the hospital six days post-operation in good condition.
In the journal article, the authors explain that surgeons should be aware of the risk of evisceration due to COVID-19 and call for further research regarding how to perform surgery to repair it, particularly with regard to the use of mesh:
COVID-19 infection has a variety of clinical and surgical presentations. To our knowledge, this is the first case of evisceration due to COVID-19 infection exacerbation. Post-operative cough is a known risk factor for fascial dehiscence and evisceration.1 Thus, performing surgery on patients who are COVID-19 positive or who become COVID-19 positive during their hospital stay should alert surgeons for potential risk of fascial dehiscence which may result in evisceration. Fascial dehiscence with evisceration is a surgical emergency with a high mortality rate and is associated with increased hospital length of stay and complications.2
There is scarce literature to support any specific technique for the repair in this particular setting. In our patient, the fascial defect was immediately repaired without mesh. Recent literature has suggested that use of mesh in contaminated fields can lead to similar outcomes to non-mesh repair in the same setting.3 However, more research needs to be done in this area in patients with COVID-19. The decision whether to use or not mesh should be made by the surgical team based on their experience.
I was able to access the short journal article here. Be forewarned, though, it contains some graphic and disturbing images of the abdominal evisceration and the surgery to address it.
Previously:
• Long COVID expert at US Senate hearing: 'the burden of disease and disability from long COVID . . . is on par with the burden of cancer and heart disease'
• The first COVID vaccine you can get is the best
