Acute abdomen in patients with SARS-CoV-2 infection or co-infection

Abstract

Purpose Patients with an acute abdomen require emergency surgery. SARS-CoV-2 infection can affect multiple organ systems, including the digestive tract. Little is known about the consequences of COVID-19 infection in emergency surgical patients. Methods Perioperative data for COVID-19 patients undergoing emergency surgery from March 1, 2020, to May 23, 2020 were collected prospectively (NCT04323644). Results During this period, 215 patients underwent surgery, including 127 patients in an emergency setting, of whom 13 (10.2%) had COVID-19. Two scenarios were identified: (a) patients who were admitted to a hospital for an acute surgical condition with a concomitant diagnosis of COVID-19, and (b) patients with severe COVID-19 developing acute abdominal pathologies during their hospital stay. When compared with those in group B, patients in group A globally recovered better, with a lower mortality rate (14.3% vs. 33.3%), lower ARDS rate (28.5% vs. 50.0%), less rates of preoperative invasive ventilation (14.3% vs. 50.0%) and postoperative invasive ventilation (28.5% vs. 100.0%), and a shorter duration of invasive ventilation. No causality between SARS-CoV-2 infection and gastrointestinal affliction was found. Conclusion Our observations underline that mild co-infection with COVID-19 did not result in more complications for emergency abdominal surgery. Howe, an acute abdomen during severe COVID-19 infection was part of an unfavorable prognosis.

Acute surgical abdomen during the COVID‑19 pandemic: Clinical and therapeutic challenges

“…of acute abdominal pain. The possibility of digestive manifestations in approximately 10% of cases, due to the binding of SARS-Cov-2 at the level of ACE receptors in the intestinal tract, with fever, abdominal pain, nausea, vomiting, transit disorders, presents with a new element of differential diagnosis on which the on-call surgical team must investigate and exclude (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Moreover, laboratory tests may show an increase in transaminases and amylases in these patients, suggesting hepatic or hepatopancreatic involvement (26)(27)(28)(29).…”

“…The thrombotic causes can be related to the direct invasion of ACE receptors in vascular endothelium, direct viral invasion of the blood vessels, or occlusion resulting from microthrombi formation and include mesenteric vessel ischemia (occlusive or non-occlusive), renal vessel infarcts, and omental infarcts (32). Non-thrombotic causes reported in the literature include pancreatitis, peritonitis, colonic distension, and colitis, and are related to the tropism of the virus to the ACE receptors along the digestive tract (34)(35)(36)(37)(38).…”

“…Clinical trials conducted during the pandemic revealed unfavorable results, with increased mortality and morbidity in patients who underwent surgery during incubation or early infection with Sars-Cov-2 (1,25,(37)(38)(39). On the other hand, in the case of certain acute surgical abdomen, and given the high incidence of infections in Bucharest, all patients presenting to the emergency department must be considered suspects until the Covid-19 RT-PCR test comes back negative.…”

Outcomes after emergency abdominal surgery in COVID-19 patients at a referral center in Brazil

“…Only a few reports have specifically evaluated emergency abdominal surgery outcomes in hospitalized patients already under treatment for COVID-19 respiratory failure. Seeliger et al described six patients, 50% of which developed acute respiratory distress syndrome (ARDS), and 33% died [ 19 ]. The same study also showed that, in seven patients with acute abdomen and SARS-CoV-2 coinfection with mild or no respiratory compromise, mortality was 14.3%, while 28.5% developed postoperative pulmonary complications.…”

With regard to the article “Acute abdomen in patients with SARS-CoV-2 infection or co-infection”

“…In order to ensure timely publication of our article “Acute abdomen in patients with SARS-CoV-2 infection or co-infection” [ 1 ], the reported follow-up was a minimum of 4 weeks for all patients who underwent emergency abdominal surgery during their COVID-19 disease. It is of importance to address the long-term outcome of surgical procedures, and particularly to determine if patients with an acute abdomen have an increased mortality risk due to a SARS-CoV-2 infection.…”