Giorgio Lisi

M. Campanelli

M. Villa

S. Grande and M. Grande

English

LETTER TO THE EDITORColorectal emergency surgery in a COVID-19 referral hospitalduring the phase 2 in ItalyGiorgio Lisi1 & M. Campanelli2 & M. Villa3 & S. Grande3 & M. Grande3Accepted: 25 June 2020# Springer-Verlag GmbH Germany, part of Springer Nature 2020Dear Editor:The outbreak of SARS-CoV-2 infection, first reported inChina in December 2019, has become a public health emer-gency of international concern that also affects patients withcolorectal disease [1]. Recently, the University Hospital ofRome Tor Vergata was named “Covid Hospital-4,” the fourthreferral center in Rome for COVID-19-positive patients. As aresult, all surgical services across the department, with theexception of the endoscopic session for oncological and ur-gent cases, were lockedwith the result that the vast majority ofsurgeons operated only in urgent cases (73.9%) [2], but thenumber of interventions significantly dropped. In the past2 weeks, the Italian government has declared “phase 2” ofthe lockdown reducing restrictions and access to hospitals aswell as outpatient. Since then, up to 40% of non-traumaticabdominal emergencies have had unusual delayed treatment[2]. We share some considerations about our first 2 weeks ofcolorectal emergency surgery during phase 2, with particularattention to the increase number of complex colorectal emer-gency cases. We reported 11 difficult cases of emergencycolorectal surgery in contrast to the same period before andduring the lockdown: 4 cases of Hinchey III and IV divertic-ulitis, 3 locally advanced colorectal cancers with intestinalobstruction, and four obstructive right colon cancer.According to the recent survey by Patriti et al. sent to 150Italian heads of General Surgery [2], about 40% of surgeonsreported an unusual delay in the presentation of non-traumaticabdominal emergencies. In all cases, the fever had been pres-ent for several days before hospitalization. The delay waspartially related to patient choice, preferring to stay at homeuntil symptoms worsened, and in part due to the waiting listfor the COVID-19 emergency room test, almost half of thecenters reported emergency associated with a more seriouspresentation due to a diagnostic delay. In our country, manypatients with fever have asked the authorities not to go to thehospital if they do not have breathing difficulties. In thesepatients, fever may not be caused by COVID-19-related pneu-monia but by an abdominal infection. There are also numerouspatients whose diagnostic delay is related to the time spent inthe emergency room, both because of the scarcity of hospitalbeds available and because of the diagnostic work forCOVID-19. Our preliminary experience recognizes some ofthe main reasons for delayed diagnosis during the COVID-19pandemic. The first is the concern of parents; families wereextremely concerned about the possibility of contractingCOVID-19 in public places such as outpatient or ER.Caregivers were reluctant to contact their primary care physi-cian, and even after a specific referral to the emergency room,they chose to refrain from visiting medical facilities. The sec-ond reason is the inadequate clinical evaluation and the con-sultation settings; in the COVID-19 era, many of the medicalactivities were conducted through a telemedicine platform thatallows patients to be assessed by limiting exposure [3].However, one of these disadvantages is the inability to con-duct a complete physical examination which can lead to anincorrect diagnosis. We are convinced that this could be thebeginning of a worse scenario; in a recent snapshot on behalfof the COVID-SURGE-ITA group [4] conducted on 54 sur-gical units in 36 Italian hospitals, the survey showed howsurgical oncology has suffered a significant reduction in ac-tivity resulting in a double waiting list, and the hub-and-spokecancer program did not work adequately, so we could proba-bly see a dramatic increase in primary symptoms related tocancer, and more patients may require an emergency approachwith a significant worse prognostic impact in the future.* Giorgio Lisigiolimas06@yahoo.it1 University Hospital of Tor Vergata, viale Oxford 81,00133 Rome, Italy2 Mininvasive Surgery Unit, University Hospital of Tor Vergata, vialeOxford 81, 00133 Rome, Italy3 Emergency Surgery Unit, University Hospital of Tor Vergata, vialeOxford 81, 00133 Rome, ItalyInternational Journal of Colorectal Diseasehttps://doi.org/10.1007/s00384-020-03684-xWhatever the reason why these patients or those of othersdelay the search for medical and surgical care during thispandemic, the concern remains that this delay will lead to anincrease in morbidity and mortality in the coming weeks andmonths. Perhaps in the future, we will see the real conse-quences on screening programs, and the effect of theCOVID-19 pandemic on our population’s non-COVID-related health could be even more devastating than COVID-19 itself.Authors’ contributions GL, MC, MV, SG, and MG contributed equallyto this work: conception, design, and drafting the work, and final approvalof the version to be published.Compliance with ethical standardsConflict of interest The authors declare that they have no conflicts ofinterest.References1. Wu Z, McGoogan JM (2020) Characteristics of and important les-sons from the coronavirus disease 2019 (COVID-19) outbreak inChina: summary of a report of 72 314 cases from the Chinese centerfor disease control and prevention. JAMA. https://doi.org/10.1001/jama.2020.26482. Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M, FACS onbehalf of the Associazione Chirurghi Ospedalieri Italiani (ACOI)(2020) Emergency general surgery in Italy during the COVID-19outbreak: first survey from the real life. World J Emerg Surg 15:363. Keesara S, Jonas A, Schulman K (2020) Covid-19 and health care’sdigital revolution. N Engl J Med 382(23):e824. Torzilli G, Vigano L, Galvanin J et al (2020) A snapshot of electiveoncological surgery in Italy during COVID-19 emergency: pearls,pitfalls, and perspectives. Ann Surg. https://doi.org/10.1097/SLA.0000000000004081Publisher’s note Springer Nature remains neutral with regard to jurisdic-tional claims in published maps and institutional affiliations.Int J Colorectal Dis

Colorectal emergency surgery in a COVID-19 referral hospital during the phase 2 in Italy

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Colorectal emergency surgery in a COVID-19 referral hospital during the phase 2 in Italy

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