• Saeed Safari, Hossein Keyvani, Malekpour AlamdariNasserNShahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Amin Dehghanian, Razavi HashemiMelikaMDepartment of Pathology, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran., Nemati HonarBehzadBImam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran., and Ali Aminian.
• Department of Surgery, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran.
• Ann. Surg. 2020 Sep 1; 272 (3): e253-e256.

AbstractMultiple tissue samples were obtained during emergent abdominal surgery in 4 patients with coronavirus disease 2019 (COVID-19) to examine for tissue involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first patient underwent a laparoscopic cholecystectomy for gallbladder empyema and died from severe respiratory failure. The second patient with Crohn disease underwent emergent laparotomy for a perforation in the terminal ileum and recovered. The third patient underwent an open appendectomy and recovered. The fourth patient underwent emergent laparotomy for a perforated peptic ulcer and died from sepsis. Although the SARS-CoV-2 RNA was found in the feces of 3 patients and in the duodenal wall of the patient with perforated peptic ulcer, real time reverse transcriptase polymerase chain reaction (RT-PCR) examination of abdominal fluid was negative for the virus. The RT-PCR did not detect viral RNA in the wall of small intestine, appendix, gallbladder, bile, liver, and urine. Visceral fat (omentum) and abdominal subcutaneous fat of 4 patients were also not infected with the SARS-CoV-2. Although this limited experience did not show direct involvement of abdominal fluid and omentum, assessment in large series is suggested to provide answers about the safety of abdominal surgery in patients with COVID-19.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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