Introduction

The ongoing COVID-19 pandemic has proven to be challenging for both healthcare workers and patients as infection with COVID-19 can cause a variety of symptoms and clinical presentations. The most common symptoms of COVID-19 infection include respiratory symptoms such as cough and shortness of breath. With elective and non-elective surgical procedures still ongoing during the COVID-19 pandemic, these symptoms can result in new, rare, and various clinical presentations in post-surgical patients. A report of a patient who presents with abdominal evisceration after contracting COVID-19 is described in this study.

Case Presentation

This is a 52-year-old female with extensive abdominal surgical history including a ventral hernia repair 13 years prior, with subsequent incarceration and multiple recurrent repairs. The patient contracted COVID-19 with bouts of coughing and presented to our hospital 5 days later with abdominal evisceration from her previous hernia repair site in her left lower quadrant (Fig. 1). The patient was resuscitated, started on antibiotics, and taken to the operating room for an emergent wound washout, reduction of bowel, and closure of fascial defect with interrupted unabsorbable stitches, subcutaneous in layer with interrupted absorbable stitches, and skin with interrupted Nylon stitches (Figs. 2, 3). The patient did well post-operatively with return of bowel function, was started on a diet on postoperative day 2, and was discharged home on postoperative day 6 in stable condition.

Fig. 1
figure 1

Evisceration from abdominal wound dehiscence

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Fig. 2
figure 2

Closure of the fascial defect

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Fig. 3
figure 3

Full closure of the abdominal wound

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Discussion

COVID-19 infection has a variety of clinical and surgical presentations. To our knowledge, this is the first case of evisceration due to COVID-19 infection exacerbation. Post-operative cough is a known risk factor for fascial dehiscence and evisceration.1 Thus, performing surgery on patients who are COVID-19 positive or who become COVID-19 positive during their hospital stay should alert surgeons for potential risk of fascial dehiscence which may result in evisceration. Fascial dehiscence with evisceration is a surgical emergency with a high mortality rate and is associated with increased hospital length of stay and complications.2

There is scarce literature to support any specific technique for the repair in this particular setting. In our patient, the fascial defect was immediately repaired without mesh. Recent literature has suggested that use of mesh in contaminated fields can lead to similar outcomes to non-mesh repair in the same setting.3 However, more research needs to be done in this area in patients with COVID-19. The decision whether to use or not mesh should be made by the surgical team based on their experience.

Conclusions

As new variants of COVID-19 continue to surface, new clinical presentations of COVID-19 are being seen. Although evisceration is a rare presentation, surgeons should be aware of the possibility and take it into account when performing surgery on patients with COVID-19. The choice of repair should be determined on an individualized basis and be up to the discretion of the surgical team.