A rare complication in a Covid-19 positive patient with sigmoid colon cancer-hemoperitoneum due to gallbladder necrosis following micro-thrombosis

Covid-19, also known as acute respiratory syndrome 2019-nCoV, severe acute respiratory syndrome (SARS) 2, and Wuhan pneumonia, is a viral respiratory disease caused by a SARS-associated coronavirus (SARS-CoV2). The most serious complications of Covid-19 are due to the development of micro-thrombosis in various organs and systems as a result of the high levels of pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin 1 and 6) which initiate the activation of coagulation and the generation of thrombin. Several studies demonstrated the poor outcome of Covid-19-infected patients who underwent surgery, suggesting that surgery may accelerate and exacerbate Covid-19 progression. We report the case of an 81-year-old patient admitted as an emergency with Covid-19 pneumonia, hemoperitoneum, ischemic acute cholecystitis and obstructive sigmoid cancer. Cholecystectomy, pneumoperitoneal lavage, and Hartmann operation were performed under combined epidural-spinal anesthesia. This technique has some advantages compared to spinal and epidural techniques, such as: rapid onset of analgesia and the possibility of obtaining the desired sensory level, control of the anesthetic block, and ensuring postoperative analgesia. The unfavorable outcome of this case is due to the occurrence of the cytokine storm and coagulation disorders, with the change in the related biological constants, both from a biochemical and systemic point of view.