A Case of Emergency Partial Small Bowel Resection for a Patient with Novel Coronavirus and Small Bowel Necrosis

Abstract

A 77-year-old woman was admitted to another hospital with a positive SARS-CoV-2 RNA test, complaining of a wet cough and fever that had started 3 days earlier. On the day of admission, she had decreased oxygenation, decreased food intake, and vomiting. A CT scan showed suspicious findings of small bowel necrosis, and the patient was transferred to our hospital. A preoperative CT scan of the chest showed no pneumonia. The patient underwent emergency laparotomy for diagnosis of peritonitis due to necrosis of the small intestine. Postoperatively, the abdominal symptoms improved, but the pulmonary infiltrate rapidly worsened and the patient died of respiratory failure on the fifth postoperative day. It has been reported that surgery in patients with SARS-CoV-2 coronavirus disease 2019 (COVID-19) is associated with higher postoperative mortality due to pulmonary complications, and it is recommended that surgery be postponed or nonoperative treatment be chosen if possible. In this case, the suspected small bowel necrosis made nonoperative management difficult, and emergency laparotomy was performed. However, postoperative pneumonia rapidly worsened and the patient died. This case suggests that the prognosis after general anesthesia surgery is poor in patients with COVID-19, even in the absence of preoperative pneumonia. Here, we report this case and discuss the literature and perioperative infection control measures.