EP.FRI.451 Laparotomy rates and factors influencing treatment modality for diverticulitis during the COVID-19 lockdown

Background

Infection control measures during the COVID-19 crisis modified diverticulitis treatment. Here we present the treatment applied in three large UK centres compared to the same timeframe in 2019. 

Methods

This was a multicentre, comparative study, whereby diverticulitis cases from March 23^rdto May 11^th2019 acted as historical controls for cases during lockdown. Severity at presentation (SD), comorbidities, treatment modality, Length of Stay (LOS), complications and COVID-19 status (CS) were recorded. Chi-squared, ANOVA, Mann-Whitney test and linear regression were used for analyses. 

Results

59 patients presented with diverticulitis in 2020 compared to 130 in 2019 (M:F 27/32, 56/74 and 64vs.62 y.o.). Laparotomy was performed in 6/59 and 12/130 respectively. Comparing 2019 to 2020, there was no statistical difference for severity (p = 0.643), treatment modality (0.946), comorbidities (0.313), LOS (0.602). Linear regression demonstrated statistically significant association between treatment employed (p < 0.001) and SD, while there was no association with age, comorbidities or CS. LOS was associated with severity only (p < 0.001), whilst CS, treatment, age and comorbidities yielded no statistical difference. 

Conclusion

Diverticulitis cases during 2020 lockdown reduced noticeably (59vs.130). There was no difference in severity, treatment, comorbidities or LOS between 2019 and 2020. Laparotomy was performed in 6/59 and 12/130 respectively. Decision about treatment and LOS in 2020 was associated with severity of disease only. There was no association with COVID status. These findings should be interpreted with caution due to small COVID positive numbers and not including ambulatory units, however, they are consistent with findings from our sister Spanish group.    

Cecal Perforation in a COVID-19 Patient Treated with Tocilizumab: A Case Report

Tocilizumab is a monoclonal antibody against the interleukin-6 receptor. Gastrointestinal perforation has been associated with Tocilizumab treatment. In the absence of specific antiviral drugs, Tocilizumab is currently being used as a treatment option in patients with severe COVID-19 pneumonia. This is being based on the implication of interleukin-6 in the aberrant host immune response that characterizes the disease and initiates patients' lung damage. Herein we present the case of a cecal perforation in a patient treated with Tocilizumab for COVID-19. In such context, we expect that there may be an increase in the incidence of gastrointestinal perforation related to Tocilizumab.

Systemic treatment of acute liver failure with adipose derived stem cells

PURPOSE OF THE STUDY

The definitive treatment for liver failure is, currently, liver transplantation. Research into other possible treatments, focused on achieving regeneration of the liver parenchyma, have led to the development of methods to generate hepatocytes from stem cells. In our study, we transplant allogenic adipose-derived stem cells (ASCs), not previously differentiated to hepatocytes, to treat acute liver failure induced by intraperitoneal administration of carbon tetrachloride (CCl4) in a Sprague-Dawley rat model.

MATERIAL AND METHODS

The ASCs were delivered via the tail vein, having previously been labeled with PKH26, a fluorescent membrane marker. Two control groups were established, Group 1(n = 15) consisting of olive oil (5 mL/kg) and Group 2(n = 15): 1 × 10(6) PKH26-labeled ASCs. Further, two study groups, Group 3(n = 30): CCl4 dissolved in olive oil and Group 4(n = 30): CCl4 dissolved in olive oil and 1 × 10(6) PKH26-labeled ASCs completed the experimental design.

RESULTS

Blood samples were analyzed, finding AST and ALT levels significantly higher in treatment over control groups at 24 and 48 hours. The mortality rates were statistically different between control groups and Group 3 (Group 1-3 p = .04, Group 2-3 p = .04) and between Groups 3 and 4 (p = .02). Examining the liver parenchyma, a significantly higher number of ASCs were observed in Group 4 than in Group 2 at all time points (p = .00).

CONCLUSIONS

The intravenous injection of allogenic ASCs in this model of CCl4-induced liver failure reduced the mortality in treated animals. ASCs injected in the rat tail vein were found in the liver in animals with induced acute liver failure.

Acute cholecystitis caused by Brucella melitensis: case report and review

Brucellosis is a common zoonosis in many parts of the world. Human brucellosis is a multisystemic disease with a wide range of clinical symptoms. Biliary involvement in the form of acute cholecystitis is a very rare manifestation of brucellosis. Here we report the case of a 34-year-old male with acute cholecystitis caused by Brucella melitensis and review seven other cases. We conclude that brucella may have a focal effect on the gallbladder, in the form of acute cholecystitis.