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Farooq. V, a 38-year-old native hailing from Ponnani, Malappuram, Kerala is a unique survivor of a disease that has an otherwise very high death rate, said Dr. Prakash K, Senior Consultant Gastrosurgery, Aster Medcity, Kochi. Mr. Faruq, with his wife Bushra & cousin brother Mr. Samad along with Team of Doctors at Aster Medcity
We all know that Covid 19 could affect the lungs, kidneys and various other organs. Post-Covid blockage of blood vessels to the intestine and massive bowel gangrene is a fatal but less known complication with a very high mortality rate. There were recent case series from Rajasthan and from western countries with equally high mortality rates. Here is our patient who had all complications of Covid 19, massive bowel gangrene, multiple surgeries, and sepsis, and yet with the persistent collective approach of the critical care team and surgeons, such a patient could also be saved. Dr. Prakash added. This patient a 38 years old daily wages worker was diagnosed to have Covid 19- infection in mid-June and later on was admitted in a Government Medical College with severe abdominal pain and weakness. Doctors know that Covid 19 infection precipitates blood clotting and can affect the lungs, kidneys, brain, and sometimes intestines. When blood vessels to the intestine are blocked due to massive thrombosis a good length of the intestine could turn non-viable and becomes gangrenous. Usually, massive bowel gangrenes is a fatal condition as it results in severe sepsis in a few hours’ time unless an emergency surgical intervention is done. During surgery, if a patient has nonviable bowel for a considerable length, the only option is to remove the dead intestine and it might result in a shortage of length of available healthy intestine for long term survival which is termed as ‘” short bowel syndrome” in medical terms. Our patient also had bowel gangrene and to save his life a good proportion of the small intestine had to be removed surgically. As the ends of bowels were not healthy for re-joining together the surgeons at Medical College brought the ends of the bowel as a stoma. However, as it was difficult to maintain him with high output stoma and the early reversal was performed. The ends of the intestine were joined together, but unfortunately, he had leakage from the bowel anastomosis and he became septic, and hence referred to Aster Medcity Kochi. At the time of admission, he was on a ventilator, partly due to resolving Covid -19 infection and partly due to ongoing sepsis, his BP and urine output were low and he was in florid sepsis. A medical team comprising Anesthesia & Critical Care Head Dr. Suresh G Nair, Consultant Dr. Jobin, and Gastro surgeons Dr. Prakash K, Dr. Kamalesh, Dr. Vipin, and Dr. Sidharth were succeeded in stabilizing patient within 6 days and removing the ventilator support. The next challenges were leaking intestines, respiratory distress, and difficulty sustaining him with nutritional support. Yet, he was not fit for another surgery to correct his leaking intestine. His general condition was improved and after 3 weeks he was more or less ready for the corrective surgery. The challenges during the surgery to correct his intestinal fistula were multi-fold. Dense adhesions due to sepsis, a short length of intestine leaving no room for additional resection of bowel, suboptimal blood supply to the bowel due to previous blood clots, and mentally and nutritionally compromised patient were the major concerns. As expected it was a difficult surgery lasting for 6 hours. With careful and painstaking dissection the gastro surgery team could identify the fistula, repair it, and join the bowel together without further length loss. His postoperative course was also stormy, but over the next 10 days, he made a slow and steady improvement and was discharged uneventfully. Aster Medcity management has also pitched in supporting the patient''s family to arrange financial help and giving necessary concessions.
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