Acute abdomen in patients with covid-19: an integrative review

LIMA, MANUELA IZIDIO DE; FONSECA NETO, OLIVAL CIRILO LUCENA DA

doi:10.1590/0100-6991e-20233576-en

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Review Article • Rev. Col. Bras. Cir. 50 • 2023 • https://doi.org/10.1590/0100-6991e-20233576-en copy

Acute abdomen in patients with covid-19: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients.

Methodology:

this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: “Acute abdomen”, “COVID-19”, “Abdominal pain” and “SARS-CoV-2” with the Boolean operator “AND”, and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective.

Results:

the relationship between tenderness in the right upper region or the presence of Murphy’s sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions.

Conclusion:

the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.

Palavras-chave:
Acute Abdomen; COVID-19; SARS-CoV-2; Abdominal Pain

Abdominal pain	Location	Patients
Diffuse	-	43.7%
Localized	Epigastrium	42.7%
	Right hypochondrium	25.5%

Abdominal pain location	Patients with dyspnea
Upper quadrant	63%
Lower quadrant	25.8%

Author	Journal/Year	Goal	Kind of study	Results	Evidence level
SEELIGER, B. et al.	Nature Public Health Emergency Collection/2020	To assess the underlying pathology and postoperative clinical course of emergency surgical patients infected with COVID-19.	Prospective study	Two groups were identified: group A, patients admitted to a hospital for an acute surgical condition with a concomitant diagnosis of COVID-19, and group 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 recovered overall better, with a lower mortality rate, lower rate of acute respiratory distress syndrome (ARDS), lower rates of preoperative invasive ventilation and postoperative invasive ventilation, and shorter duration of invasive ventilation.	II
Author	Journal/Year	Goal	Kind of study	Results	Evidence level
AZIZ, A. et al.	Cureus/2022	To assess clinical and laboratory features in adult patients with COVID-19 infection and acute pancreatitis (AP) and to determine if there is any relationship between AP and COVID-19 infection.	Systematic review	The development of AP from SARS-CoV-2 infection has been verified. The most common clinical presentation was abdominal pain.	I
BALAPHAS, A. et al.	Sci Rep./2022	To clarify patterns of abdominal pain related to SARS-CoV-2 infection during the pandemic and their relationships with serious clinical outcomes of COVID-19, modification of liver function tests (LFT), and other clinical features.	Retrospective study	The patients presented spontaneous abdominal pain and pain upon abdomen palpation. Spontaneous pain was most often located in the epigastric and right upper quadrant regions. Tenderness in the upper right region has been associated with severe COVID-19. Patients with a history of lower abdominal pain experienced dyspnea less frequently when compared with patients with a history of upper abdominal pain. Baseline elevation of transaminases was associated with a history of pain in the epigastrium and upper right region.	II
HABEEB, T. et al.	Int J Surg./2022	To assess the incidence, severity, and risk factors for recurrent appendicitis in patients treated without AI after successful AA drainage during the COVID-19 pandemic.	Prospective study	Recurrent appendicitis occurred in patients undergoing AA drainage during 1 year of follow-up. This is attributed to the fact that the COVID-19 pandemic induces vasculitis and thrombotic occlusion of arteries, including the appendicular artery. Additionally, the COVID-19 pandemic causes hyperplasia of the lymphoid tissue in the appendix wall, causing obstruction.	II
SERBAN, D. et al.	Exp The Med./ 2021	Investigated the effects of the COVID-19 pandemic on the clinical presentation and therapeutic management of the surgical acute abdomen.	Retrospective study	The main types of pathology in both groups included: Occlusions and peritonitis. SARS-CoV-2 infection can cause abdominal pain and should be considered in different diagnoses of acute abdomen.	II
KARIYAWASAM, J. et al.	Trans R Soc Trop Med Hyg./2021	Describe the gastrointestinal manifestations of COVID-19 and discuss the possible mechanisms and aspects related to its diagnosis and treatment.	Systematic review	Most gastrointestinal symptoms associated with COVID-19 include diarrhea, nausea, vomiting, and abdominal pain/discomfort. The patients had an acute abdomen with etiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, intestinal ischemia, hemoperitoneum, and abdominal compartment syndrome.	I
Author	Journal/Year	Goal	Kind of study	Results	Evidence level
HAYASHI, Y. et al.	J Gastroenterol./2021	Determine whether the presence of GI symptoms contributed to the severity of COVID-19 and identify GI symptoms characteristic of severe COVID-19.	Systematic review and meta-analysis	Abdominal pain is likely to be characteristic of severe COVID-19. Compared to other viral infectious diseases that primarily infect the respiratory system, patients with COVID-19 may have a slightly lower frequency of diarrheal symptoms with abdominal pain.	I
MCNABB-BALTAR, J. et al.	Am J Gastroenterol./2020	To assess the frequency and characteristics of hyperlipasemia in patients with COVID-19.	Retrospective study	Gastrointestinal symptoms were common among patients with hyperlipasemia, including nausea, general abdominal discomfort, and diarrhea. Among patients with hyperlipasemia, some required ICU admission and others died.	II
ALAKUS, Ü. et al.	Ulus Travma Acil Cerrahi Derg./2022	To examine the effect of the pandemic on the diagnosis and treatment of acute appendicitis.	Retrospective study	Patients who developed acute appendicitis during COVID-19 had the same clinical findings as patients who previously developed SARS-CoV-2 infection, but the frequency of presentation of such pathology was higher during the pandemic.	II
NICOLESCU, C. et al.	Surgery/2021	Analyze the difference between the surgical management of patients during the pandemic and non-pandemic periods, and determine the challenges and management of acute abdomen cases in the pandemic.	Retrospective study	The average time from admission to the surgical procedure was longer in the pandemic period, and there was an increase in operative time. The length of stay was longer in the pandemic period. Overall mortality more than doubled.	II
GEORGAKOPOULOU, V. et al.	Ann Saudi Med./2022	Review and analyze all reported cases of Acute Pancreatitis associated with COVID-19, reporting demographic data, clinical features, laboratory findings, and results.	Systematic review	Lipase and amylase were greater than three times the upper limit of normal (ULN), while the white blood cell count was elevated in most cases. The most frequent gastrointestinal, respiratory, and general symptoms were abdominal pain, dyspnea, and fever, respectively.	I

Dysfunction	Dyspnea, ICU, Death	Pain location
Hepatic	Higher probability	Right hypochondrium
Intestinal	Lower probability	Epigastrium
Intestinal	Lower probability	Lower hemiabdomen

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