НЕЙРОЭНДОКРИННАЯ ОПУХОЛЬ СЛЕПОЙ КИШКИ, ОСЛОЖНЕННАЯ НЕКРОЗОМ СТЕНКИ НА ФОНЕ COVID-19

Abstract

Aims/Objectives. The purpose of this work is to analyze the diagnosis and treatment of a neuroendocrine tumor of the caecum complicated by wall necrosis, peritonitis in the presence of COVID-19 infection. Materials and methods. The results of the examination and treatment of a 63-year-old patient L., who was hospitalized in the surgical department with a diagnosis of acute intestinal obstruction, were analyzed. History of appendectomy. Biological material was tested for Covid-19 infection (September 5, 2021): SARS-CoV-2 coronovirus RNA was not detected. When controlling the passage of barium suspension through the intestines, it was established: a contrast mass along the colon. There are abnormal fluid levels in the mesogastrium. Areas of narrowing of the right and left flanks of the large intestine are determined. On the third day, symptoms of peritoneal irritation appeared. Operated. There is a cloudy effusion in the abdominal cavity. In the right iliac region, an infiltrate is determined, formed by the caecum, ascending colon, terminal ileum, sigmoid, strand of the greater omentum. There are also fibrin plaques here. The dome of the caecum is black. In the intestine, palpation is determined by volume formation dense, spreading to the proximal section of the ascending colon and the terminal section of the ileum. Performed right-sided hemicolectomy with anastomosis "end to side", lymph node dissection D 2. Performed sanitation and drainage of the abdominal cavity. Results and discussion. The next day after surgery, the patient is in the ICU. Severe condition. Not adequate. Excited. Body temperature - 36.4C. Breathing is independent, auscultatory is somewhat weakened in the lower sections, single dry rales. Respiratory rate - 16/minute, SpO2 - 97-98% against the background of humidified oxygen insufflation at a rate of 1.5 liters/minute. Hemodynamics stable: blood pressure - 137/105 mm Hg. Art. Heart rate - 80 beats / min. Cardio monitoring - sinus rhythm. Abdomen: responds to palpation in the area of the postoperative wound. Peristalsis is sluggish. Rapid test for SARS-CoV-2 antigen No. 784 is positive. Ag SARS-CoV-2 - detected (09/08/2021). Histological conclusion: highly differentiated neuroendocrine tumor of the caecum with germination of the intestinal wall, ingrowth into the periintestinal fatty tissue. Resection margins: no tumor growth. Phlegmonous-ulcerative typhlitis. Focal phlegmonous-purulent peritonitis. Omentit. On the 6th day the patient is conscious and takes food. Removed drainage from the abdominal cavity. On the 7-th day, he was transferred to the infectious diseases department of another hospital for aftercare. Сonclusions 1. PCR test does not always detect Covid-19 if present. 2. Despite the presence of Covid-19 in patients suffering from a complicated malignant tumor of the intestine, a radical operation should be performed followed by treatment of the underlying pathology.