背景:SARS-Cov-2不仅感染成年人,还有孩子,包括小儿外科急腹症患者。这里,我们报告了一例小儿手术病例,其中腹股沟嵌顿疝和疑似COVID-19.
方法:一名11个月大的男性被带到我们的急诊科,主诉是在入院前一天反复出现的黄绿色呕吐。还报告了高烧和呼吸急促。该患者还患有中度脱水。既没有发现与确诊的COVID-19病例接触的历史,也没有发现从任何当地传播区域旅行的历史。然而,SARS-CoV-2快速抗体测试显示阳性结果。发现左侧阴囊中的肿块在入院期间持续存在。进行液体复苏和放置鼻胃管减压。尝试手动减少,但未能减少肿块。因此,我们决定使用三级保护法规进行紧急高位结扎,即,COVID-19的完整个人防护装备(PPE)。术中,我们发现一个小肠环被困在阴囊里,卡在腹股沟管中。术后,在等待实时逆转录聚合酶链反应(RT-PCR)结果的同时,继续将婴儿作为COVID-19患者进行治疗.
结论:手法复位术是儿童腹股沟嵌顿疝的标准治疗方法。手动还原的成功率约为70%,因此,如果手动还原失败,紧急手术是强制性的。在COVID-19大流行期间,所有医疗程序都需要明确患者的状态,包括是否感染了COVID-19。除了适当的预防措施,在手术过程中必须格外小心,以最大程度地减少医务人员交叉感染的风险。
结论:在COVID-19大流行期间,外科医生应始终意识到患者交叉传播的可能性,因为儿童也容易感染SARS-CoV-2。无论何时何地,外科医生应以最快,最有效的方式进行手术,以缩短患者和麻醉气雾剂的暴露时间,并使用适当的PPE。
BACKGROUND: SARS-Cov-2 infects not only adults, but also children, including pediatric surgery patients with acute abdomen. Here, we report a pediatric surgery
case with incarcerated inguinal hernia and suspected COVID-19.
METHODS: A 11-month-old male was brought to our emergency department with the main complaint of recurrent yellowish-green vomiting that was experienced from one day before admission. High fever and shortness of breath were also reported. This patient was also suffering from moderate dehydration. Neither history of contact with a confirmed
case of COVID-19 nor traveling from any local transmission area were found. However, a SARS-CoV-2 rapid antibody test revealed a positive result. A lump in the left scrotum that persisted during admission was found. Fluid resuscitation and nasogastric tube placement for decompression was performed. Manual reduction was attempted but failed to reduce the lump. Accordingly, we decided to perform an emergency high ligation using tertiary protection regulations, i.e., full personal protective equipment (PPE) for COVID-19. Intraoperatively, we found a small intestine loop trapped in the scrotum and stuck in the inguinal canal. Postoperatively, the baby was continued to be managed as a patient with COVID-19 while waiting for the real-time reverse transcription polymerase chain reaction (RT-PCR) results.
CONCLUSIONS: Manual reduction is standard treatment for incarcerated inguinal hernia in children. The successful rate of manual reduction is about 70%, therefore, if the manual reduction fails, an emergency surgery is mandatory.During the COVID-19 pandemic, all medical procedures require clarity of the patient\'s status including whether infected with COVID-19. Along with proper precautions, great care must be taken during surgery to minimize the risk of cross infection to health workers.
CONCLUSIONS: During the COVID-19 pandemic, surgeons should always be aware of the possibility of cross-transmission from the patient, since children are also susceptible to SARS-CoV-2 infection. When and wherever possible, surgeons should perform the procedure in the quickest and most effective manner to shorten exposure time with patient and anesthetic aerosols as well as using appropriate PPE.