ACS: COVID-19 Emergency General Surgery Guidelines

Laila Zomorodian, MD
Mar 25, 2020
1 min read

From ACS: COVID-19 and Surgery

Online March 24, 2020

Acute Hemorrhoidal Thrombosis/Necrosis If >48 hrs and pain is controlled, defer operation.

If localized, excision under local anesthesia in outpatient setting.

If extensive, excise in OR under regional or general anesthesia.

Perirectal Abscess Use systemic antibiotics as indicated.

If superficial and localized, incision and drainage with local anesthesia.

If large and/or deeply located abscesses consider interventional radiology

Incision and drainage in OR as indicated.

Acute Pancreatitis with Necrosis Supportive care and resuscitation. Antimicrobial therapy if infection present or suspected. Use recommended “step up” approach.

Drainage and debridement endoscopically or by interventional radiology.

Manage laparoscopically or open in OR if no other option available. Refer to SAGES guidelines for safe use of laparoscopic approaches.

Pneumoperitoneum, Intestinal Ischemia, Intestinal Obstruction Laparotomy vs. Laparoscopy as indicated

Appendicitis, Uncomplicated IV antibiotics, transition to PO antibiotics

Appendicitis, Complicated

Abscess: IR drainage and IV antibiotics, transition to PO antibiotics
Phlegmon: IV antibiotics, transition to PO antibiotics
Perforation: IV antibiotics, transition to PO antibiotics, consider IR drainage if associated abscess

Symptomatic Cholelithiasis

Defer intervention if pain control achievable. If not, percutaneous cholecystostomy whenever possible

Acute Cholecystitis Percutaneous cholecystostomy whenever possible, IV antibiotics, transition to PO antibiotics

Cholangitis ERCP, IV antibiotics, consider percutaneous cholecystostomy tube vs. cholecystectomy dependent on individual patient comorbidities

Choledocholithiasis

ERCP, with sphincterotomy; deferred cholecystectomy

Diverticulitis, Uncomplicated IV antibiotics, transition to PO antibiotics

Diverticulitis, Complicated