Comment on: SARS-Cov-2 in peritoneal fluid: an important finding in the Covid-19 pandemic.

Editor

We read with great interest the article recently published by Barberi et al, in which the authors identified the presence of a positive swab for SARS-Cov-2 from the abdominal fluid in a 71-year-old COVID-19 positive woman who underwent a subtotal colectomy with terminal ileostomy. The authors stated that this was the first case in which the SARS-CoV-2 was identified within the abdominal cavity. We would sincerely congratulate the authors for their interesting report, that however confirms the findings we have already reported in a previous publication. We documented the presence of the SARS-CoV-2 in the peritoneal fluid of a positive 78-year-old male who underwent surgery for small bowel occlusion. The patient recovered well and was discharged in post-operative day 10. Interestingly, the nasal swab contained less SARS-Cov-2 RNA virus compared to the viral peritoneal fluid, which resulted comparable to the nasal swab when retested 10-fold diluted. The presence or not of the SARS-Cov-2 in the peritoneal fluid is a lively matter of debate in the recent COVID literature. In fact, to our knowledge there are only two reports in which SARS-CoV-2 was not detected on multiple samples of the peritoneum in COVID-19 positive operated patients,. No shareable messages were given in both reports. A potential SARS-CoV-2 positivity of the peritoneal fluid may dramatically influence the grade of exposure of the operating team to COVID-19-contaminated aerosol during laparoscopy or open surgery. For that reason, several precautions should be taken during an operation, including the use of full personal protective equipment, minimizing the number of medical personnel, evacuation of smoke with suction devices and, in case of laparoscopy, avoiding two-way pneumoperitoneum insufflators, and maintaining pneumoperitoneum pressure and ventilation at the lowest possible levels,. Furthermore, we believe that the use of devices capable of filtering released CO2 for aerosolized particles should be strongly recommended during laparoscopic surgery, where possible. A multicenter study focusing on the sampling of peritoneal fluid in operated SARS-COV-2 patients would be mandatory in order to assess the real prevalence of the abdominal positivity of SARS-COV-2 RNA virus.