Intento autolitico con herida cervical en paciente COVID

Abstract

Introduction and objective: The Covid pandemic has caused, in addition to the huge number of infected with sequelae and deaths, an economic crisis of severe repercussions that, added to the limitations in terms of social interaction in periods of confinement, can trigger or accentuate psychiatric pathologies in some people. The maximum expression of any of these disorders is suicide, as in the case we present. Method: A 55-year-old male with a history of depression in 2008 who was resolved with medication and psychological support. As a result of the closure of his business due to the pandemic, added to family problems, he suffers a relapse in his depressive mood, which leads him (September 2020) to try to take his own life causing serious head injuries from blows and several wounds on the wrists and neck with a large knife. His history was unknown and that he was infected by Covid, a fact that was verified in the screening PCR when he was already in the operating room.  Upon admission we verified the presence of a large knife (18 X3 cm of blade) deeply nailed to the left side of the neck, from the level of the thyroid to the occipital condyle, as well as other incised wounds on both wrists and right side of the neck, and an extensive scalp for cranial blunt incision wounds, which did not cause fractures.  After an urgent CT scan he is transferred to the operating room, and a regulated tracheostomy was performed and the knife was removed, which went through the pharynx and the floor of the mouth and lodged in the left occipital condyle, and all the wounds and sectioned cervical spaces were checked and sutured 12 days after he was discharged from the ICU and transferred to the Psychiatry plant for worsening. After 2 months of admission he was discharged Results: After the surgery, which was performed by the doctors on call of ENT, C. Vascular and C. Oral and Maxillofacial, he is transferred to the Covid plant and a few hours later to the ICU for severe pneumonia.  12 days later he was discharged from the ICU and transferred back to the Internal Medicine plant from which, the next day, he was sent to the acute psychiatry plant for worsening. The evolution was satisfactory although it required swallowing rehabilitation due to dysphagia, closing the tracheostomy and removing the probe once corrected, and, after 2 months of admission to Psychiatry, once the treatment was adjusted, he was discharged without further incidents. Discussion: This case of serious psychiatric episode with autolytic attempt that required urgent cervical surgery is presented, to illustrate some of the collateral effects of the Covid pandemic that, tangentially, required our attention as head and neck surgeons. Conclusions: The Covid pandemic is also causing an upwelling and aggravation of psychiatric disorders, which is leading some patients to the decision to commit suicide.