Case 2
A 76 years-old male patient was admitted to Emergency Unit with mild dyspnea, cough, oxygen saturation of 91% on room air, and myalgias. CoViD-19 infection was discovered by a RT-PCR nasopharyngeal swab. Thoracic CT was negative for signs of CoViD pneumonia and patient was admitted in CoViD Unit requiring just oxygen therapy. No cortisone was administered.
Three days after, he developed severe epigastric pain radiating to the back, with nausea and vomiting. Laboratory tests showed elevated lipase (916 U/L; n. v. 25-125 U/L) and amylase (396 U/L; n. v. 8-78 U/L) levels. Abdominal US revealed pancreas diffusely enlarged, with low density, non-bordered peri-pancreatic collections in the body area, without focal lesions, normal gallbladder, common and intra-hepatic bile ducts, and absence of biliary stones. AP diagnosis in CoViD patient was performed, and standard therapy with fluid and antibiotics was introduced. The medical history did not reveal potential aetiologias of AP.
Following 10 days, acute abdominal pain, nausea, vomiting, fever (39,2 °C), chills developed. Blood test revealed leucocytosis (WBC 31.000 x 103/UL; n. v. 4,8-10,8 x 103/UL), and increased of both ESR (87 mm/h) and C-reactive proteine (238 mg/L).
The abdominal CT scan showed a PP (11x6x9 cm) developing in the anterior pancreatic body area. An endoscopic ultrasound-guided trans-gastric drainage of the PP was performed and a Hot Spaxius 16 mm stent (Tae Woong Medical, Gojeong-ro, Wolgot-myeon, Gimpo-si, Gyeonggi-do, South Korea) was successfully placed (Figure 2 A, 2B).
The presence of Covid-19 in the aspirated fluid was confirmed by the same RT-PCR analyses performed in the other patient.
Ten days after, a TC scan control showed the regular stent placement and a reduction of more than 90% of the fluid collection diameter (Figure 2C). The patient had an uneventful recovery with gradual resolution of abdominal and pulmonary symptoms and was discharged 31 days following admission with a planned US for stent removal.