key: cord-0935352-5x2kpgvd
authors: Saeed, U.; Sellevoll, H. B.; Young, V. S.; Sandbæk, G.; Glomsaker, T.; Mala, T.
title: Covid‐19 may present with acute abdominal pain
date: 2020-04-28
journal: Br J Surg
DOI: 10.1002/bjs.11674
sha: eb9c860ade5efdc56e581085c60e0c4948d5ff9f
doc_id: 935352
cord_uid: 5x2kpgvd

nan

COVID-19 during diagnostic work-up were included. All patients underwent routine screening for COVID-19 before entering hospital. Patients with suspected COVID-19 were isolated and tested for SARS-CoV-2.

In total, 76 patients were admitted with acute abdominal pain as their main complaint. Nine patients (11⋅8 per cent) were diagnosed with COVID-19 and were included in this study. Median age (range) was 48 (31-81) years. Patient findings from the workup are shown in Table 1 . Following a positive COVID-19 test, patients were re-evaluated for respiratory tract symptoms, which they denied having experienced. In five patients, suspicion of COVID-19 was made from pulmonary findings on acute CT performed for abdominal symptoms. All five subsequently tested positive for SARS-CoV-2. The remaining four patients were diagnosed directly using reverse-transcription polymer chain reaction on oro-and nasopharyngeal swabs. Six patients had no findings on abdominal CT while showing typical findings of COVID-19 on chest CT. All patients were discharged to selfisolation at home. No patient needed ICU treatment.

Although causal relationship between SARS-CoV-2 and abdominal pain cannot be deducted from our limited observations, findings indicate that COVID-19 can present with abdominal pain without respiratory symptoms. A potential explanation could be the presence of cellular angiotensin-converting enzyme 2 (ACE2) in several abdominal organs 3 , making them susceptible to viral infection as SARS-CoV-2 binds to ACE2 4 .

In the initial phase of the pandemic, our screening criteria for COVID-19 did not include symptoms of abdominal pain. Several patients were first isolated and tested after CT raised suspicion, forcing numerous health professionals into quarantine. CT is performed in the acute setting for these patients and may identity those with unestablished COVID-19 early. However, since three of nine chest CTs were negative, our limited data indicate a low sensitivity for CT as a screening tool for COVID-19.

There are several recommendations on safe practice to reduce the risk of infection during surgery 2,5 , however abdominal pain as a symptom in acute surgical patients is not discussed in detail. From our limited experience, we believe awareness of acute abdominal pain as a potential symptom of COVID-19 could reduce the risk of viral transmission to healthcare providers and spread of the infection within hospitals. Modifications have been made to our institutional protocols for acute admission and diagnostic work-up of patients with abdominal pain during the pandemic 6 . Droplet isolation and testing for COVID-19 are now performed on all patients with upper abdominal pain, all patients with abdominal pain (irrespective of location) and fever, and all patients presenting with abdominal pain during quarantine. CT of the chest is performed routinely in all adults undergoing CT of the abdomen for acute abdominalpain.

Clinical characteristics of coronavirus disease 2019 in China

COVID-19 pandemic: perspectives on an unfolding crisis

Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection

Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

Global guidance for surgical care during the COVID-19 pandemic

Acute abdomen as an early symptom of COVID-19