Impacto de la pandemia por coronavirus 2 (SARS-COV 2) en la forma de presentación y evolución de la apendicitis en el hospital Belén de Trujillo
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Date
2023-03-27
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Universidad Nacional de Trujillo
Abstract
La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente 1. Se informa que el riesgo en la vida de desarrollar apendicitis es de aproximadamente el 8%.2 Las Causas de apendicitis aguda como obstrucción luminal, predisposición genética factores ambientales son ampliamente discutidos. Los síntomas típicos en pacientes con apendicitis aguda son dolor en el cuadrante inferior derecho o dolor abdominal central con migración a la fosa ilíaca derecha, así como fiebre, náuseas, vómitos o estreñimiento. Las técnicas de imagen, principalmente ecografías, la tomografía computarizada o la resonancia magnética se utiliza a menudo para asegurar el diagnóstico. La apendicitis se puede dividir en flemonosa, gangrenosa y perforada que conduce a peritonitis o absceso.1,3
El retraso en el diagnóstico puede causar complicaciones como perforación apendicular, absceso apendicular, peritonitis, sepsis y muerte 4,5. Debido a la pandemia por el nuevo coronavirus (COVID-19), en el Perú, el 05 de marzo del 2020 se confirmó el primer caso importado por COVID-19, en una persona con historial de viajes a España, Francia y República Checa, desde esa fecha hasta el 06 de mayo de 2021 se han informado 1 832 671 casos confirmados de COVID-19, 9 650 927 casos negativos y 63 223 defunciones 6. El miedo de asistir al hospital generado por la pandemia pudo condicionar la demora desde el inicio de la sintomatología abdominal hasta el momento de la consulta 7, y, por ende, llevar a la presentación de cuadros más evolucionados y al desarrollo de complicaciones postoperatorias 5.
En nuestro hospital desde el inicio de la pandemia, por medida sanitaria, fue catalogado por hospital de atención no COVID, por ende, uno de los requisitos para el ingreso es contar con algún examen que confirme no estar infectado con la COVID 19 y no presentar síntomas respiratorios. La toma de pruebas para descarte de COVID 19 (Serológica, antigénica o molecular) son el primer motivo de retraso en la atención de pacientes con cuadro de apendicitis aguda, a esto se asocia la disminución de personal sanitario por comorbilidades asociadas a la RM 448-2020- MINSA.
En este contexto se lleva a cabo este trabajo con el propósito de mejorar el flujo de atención en la emergencia del Hospital Belén de Trujillo, para disminuir las posibles complicaciones descritas.
Acute appendicitis (AA) is the most common abdominal surgical emergency 1. The lifetime risk of developing appendicitis is reported to be approximately 8%. 2 Causes of acute appendicitis such as luminal obstruction, genetic predisposition, environmental factors are widely discussed. . Typical symptoms in patients with acute appendicitis are pain in the right lower quadrant or central abdominal pain with migration to the right iliac fossa, as well as fever, nausea, vomiting or constipation. Imaging techniques, mainly ultrasound, computed tomography or magnetic resonance imaging are often used to ensure the diagnosis. Appendicitis can be divided into phlegmonous, gangrenous and perforated which leads to peritonitis or abscess.1,3 Delay in diagnosis can cause complications such as appendiceal perforation, appendiceal abscess, peritonitis, sepsis and death 4,5. Due to the new coronavirus (COVID-19) pandemic, in Peru, on March 5, 2020, the first imported case of COVID-19 was confirmed, in a person with travel history to Spain, France and the Czech Republic. From that date until May 6, 2021, 1,832,671 confirmed cases of COVID-19, 9,650,927 negative cases and 63,223 deaths have been reported 6. The fear of attending the hospital generated by the pandemic could have conditioned the delay from the onset of abdominal symptoms until the moment of consultation 7, and, therefore, lead to the presentation of more advanced symptoms and the development of postoperative complications 5. In our hospital since the beginning of the pandemic, due to health measures, it was classified as a non-COVID care hospital, therefore, one of the requirements for admission is to have an exam that confirms not being infected with COVID 19 and not presenting respiratory symptoms. The taking of tests to rule out COVID 19 (Serological, antigenic or molecular) is the first reason for delay in the care of patients with acute appendicitis, this is associated with the decrease in health personnel due to comorbidities associated with MRI 448- 2020- MINSA. In this context, this work is carried out with the purpose of improving the flow of care in the emergency of the Belén Hospital in Trujillo, to reduce the possible complications described.
Acute appendicitis (AA) is the most common abdominal surgical emergency 1. The lifetime risk of developing appendicitis is reported to be approximately 8%. 2 Causes of acute appendicitis such as luminal obstruction, genetic predisposition, environmental factors are widely discussed. . Typical symptoms in patients with acute appendicitis are pain in the right lower quadrant or central abdominal pain with migration to the right iliac fossa, as well as fever, nausea, vomiting or constipation. Imaging techniques, mainly ultrasound, computed tomography or magnetic resonance imaging are often used to ensure the diagnosis. Appendicitis can be divided into phlegmonous, gangrenous and perforated which leads to peritonitis or abscess.1,3 Delay in diagnosis can cause complications such as appendiceal perforation, appendiceal abscess, peritonitis, sepsis and death 4,5. Due to the new coronavirus (COVID-19) pandemic, in Peru, on March 5, 2020, the first imported case of COVID-19 was confirmed, in a person with travel history to Spain, France and the Czech Republic. From that date until May 6, 2021, 1,832,671 confirmed cases of COVID-19, 9,650,927 negative cases and 63,223 deaths have been reported 6. The fear of attending the hospital generated by the pandemic could have conditioned the delay from the onset of abdominal symptoms until the moment of consultation 7, and, therefore, lead to the presentation of more advanced symptoms and the development of postoperative complications 5. In our hospital since the beginning of the pandemic, due to health measures, it was classified as a non-COVID care hospital, therefore, one of the requirements for admission is to have an exam that confirms not being infected with COVID 19 and not presenting respiratory symptoms. The taking of tests to rule out COVID 19 (Serological, antigenic or molecular) is the first reason for delay in the care of patients with acute appendicitis, this is associated with the decrease in health personnel due to comorbidities associated with MRI 448- 2020- MINSA. In this context, this work is carried out with the purpose of improving the flow of care in the emergency of the Belén Hospital in Trujillo, to reduce the possible complications described.
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Keywords
Apendicitis, Pandemia, Coronavirus