COVID-19 with abdominal symptoms and acute abdominal pain: a guide to identification for general practice

STRATEGIES FOR TREATING PATIENTS WITH ABDOMINAL PAIN DURING THE EPIDEMIC

Acute abdominal pain is a common clinical manifestation in medical institutions, often accompanied by nausea, vomiting, diarrhoea, and fever, which is a difficult clinical problem for emergency physicians and surgeons. In a special epidemic situation such as this, the differential diagnosis of acute abdominal pain has become more complicated. As mentioned earlier, abdominal symptoms can be the initial clinical presentation of patients with COVID-19, so clinicians should be especially careful not to admit patients with COVID-19 as patients with acute abdominal pain to a general ward without strict isolation measures. Currently, SARS-CoV-2 is raging in many regions of the world. Therefore, the timely and effective identification of patients with COVID-19 with abdominal symptoms will help prevent spread of the virus.

This article proposes an effective coping strategy for patients with acute abdominal pain during the SARS-CoV-2 epidemic. It has the following four aspects:

First, clinicians should find out the patient’s medical history in detail, especially the epidemiological history.

It is known that the incubation period of COVID-19 ranges from 1–14 days, most commonly from 3–7 days. Therefore, it is important to ask whether there is a history of exposure to suspected or confirmed cases of COVID-19 within 2 weeks for each patient with abdominal symptoms.

Second, clinicians, especially surgeons, should be familiar with not only the common symptoms of COVID-19, but also the gastrointestinal and abdominal symptoms of the disease, so as to avoid misdiagnosing COVID-19 as an acute abdomen and admitting patients to the general surgical ward, thus helping reduce infections among inpatients and medical personnel.

Third, patients should be given a comprehensive physical examination, especially an abdominal physical examination. For surgical acute abdominal pain, specific pain sites can often be found; there are even signs of peritonitis such as abdominal tenderness, rebound tenderness, and abdominal muscular defence.

Finally, patients should be given reasonable auxiliary examination methods, such as a blood test, virus pathogen detection, and imaging. In the early stages of COVID-19, white blood cell and neutrophil counts do not increase, while lymphocyte counts decrease in most patients.^6,8

Consequently, the routine blood test is one of the important auxiliary methods to predict COVID-19. Viral nucleic acid testing is essential for the diagnosis of COVID-19, but it often requires the collection of multiple samples at different points in time because of the presence of false negative results. In emergency situations, it is difficult to rely on viral nucleic acid testing to identify COVID-19 quickly. Hence, CT-scans of the lungs should be used to screen for COVID-19 in emergency situations, especially before emergency surgery. Wang et al⁴ have reported that lung CT findings of almost all patients with COVID-19 show ground-glass opacity during the disease progression.

Thus, lung CT is also one of the important methods for screening COVID-19, but the final confirmation of COVID-19 diagnosis still depends on viral nucleic acid testing. If the patient’s condition is stable, a CT-scan of the abdomen combined with lungs is recommended for all patients with acute abdominal pain during the epidemic.