SARS-CoV-2 Is Present in Peritoneal Fluid in COVID-19 Patien
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Get authentic, real-time news that helps you fight COVID-19 better.
Install PlexusMD App for doctors. It's free.
The actual pandemic posed several safety issues especially for those categories not directly involved in airway management. In fact, thousands of health care workers have been infected and died amid the ongoing coronavirus outbreak. Actually, they must be among the best-protected people. They face long hours, changing protocols, potential medical supply shortages, and pose at risk their own personal health and that of their loved ones.

SARS-CoV-2 RNA has been found in blood and feces of COVID-19 patients. The presence in the peritoneal fluid has never been demonstrated. The present article is the very first one showing that SARS-CoV-2 is present in peritoneal fluid.

The patient in whom the virus was detected was a 78 years’ old man who came to the hospital from his house for abdominal pain associated with alteration of the alvus. At the admission, associated with the signs and symptoms of intestinal occlusion, he presented fever, cough, and mild respiratory symptoms with O2 saturation of 92% maintained with an O2 therapy at 2 lt/min with nasal cannula. His medical history was positive for arterial hypertension, type II diabetes insulin-dependent, atrial fibrillation, mild chronic renal insufficiency, asymptomatic abdominal aortic aneurysm (maximum diameter 5 cm), and previous open appendectomy (20 years ago). The respiratory nasal swab was positive for SARS-CoV-2.

He was admitted with a diagnosis of intestinal mechanical obstruction due to small bowel volvulus associated to SARS-CoV-2 pneumonia. He was operated and at the laparotomy free reactive clear fluid was found. The volvulus was due to an omental band attached to the right iliac fossa. Two swabs were obtained from peritoneal fluid and sent for SARS-CoV-2 detection. Adhesiolysis was performed without intestinal resection. After the intervention, the patient was sent awake to the COVID medical ward. His respiratory condition after the intervention remained stable. 98% O2 saturation was maintained with a Venturi mask with FiO2 of 35%, gradually diminished up to complete independence from O2 therapy. The postoperative period was uneventful, and the patient was discharged at home in postoperative day 10. Two respiratory nasal swabs collected 24 hours apart and performed before discharge were negative.

This new result poses an important warning for the safety of the operating staff and requests an immediate update of the rules to protect surgical teams. All surgical procedures in fact may potentially provoke aerosolization of the virus and the infection of the personnel. Either laparoscopic or open surgical procedures may result in a gas/vapor forming maneuver. Electrocautery, advanced coagulation, and cutting devices produce gas and vapor that aerosolize the peritoneal fluid and consequently the virus. Previous studies demonstrated activated corynebacterium, human papillomavirus, hepatitis B virus, and human immunodeficiency virus in surgical smoke.

S S and 4 others like this2 shares