1Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
2Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Am J Trop Med Hyg. 2021 Jan;104(1):52-59. doi: 10.4269/ajtmh.20-0983.
Dengue infections are increasing globally and account for significant morbidity and mortality. Severe dengue results in microvascular changes and coagulopathy that may make surgical intervention risky and the overall surgical management challenging. We outline the potential surgical manifestations and complications following dengue infections and describe the clinical, pathogenetic, diagnostic, and treatment aspects of dengue and surgical patients. The main surgical presentations were acute cholecystitis, acute pancreatitis, acute appendicitis, splenic rupture, bowel perforation, gastrointestinal bleeding, and hematomas. Dengue may also mimic an acute abdomen without any true surgical complications. A majority were treated nonoperatively. Misdiagnosis and unnecessary surgical intervention resulted in poor outcomes. Better knowledge of the potential surgical complications would help in early diagnosis, treatment, and referral to specialized centers and thus improve outcomes. A high degree of suspicion of dengue fever is necessary when patients in a dengue-epidemic area present with acute abdomen or bleeding manifestations. In endemic areas, early dengue antigen testing and abdominal imaging before surgical intervention may help in the diagnoses. Multidisciplinary team involvement with case-by-case decision-making is needed for optimal care.
登革热感染在全球范围内呈上升趋势，导致发病率和死亡率显著升高。重症登革热可导致微血管变化和凝血功能障碍，使手术干预风险增加，整体手术管理具有挑战性。我们概述了登革热感染后的潜在手术表现和并发症，并描述了登革热和外科患者的临床、发病机制、诊断和治疗方面。主要的外科表现为急性胆囊炎、急性胰腺炎、急性阑尾炎、脾破裂、肠穿孔、胃肠道出血和血肿。登革热也可能没有任何真正的手术并发症而表现为急性腹痛。大多数患者接受了非手术治疗。误诊和不必要的手术干预导致了不良结局。更好地了解潜在的手术并发症有助于早期诊断、治疗和转介到专门的中心，从而改善结局。当登革热流行地区的患者出现急性腹痛或出血表现时，需要高度怀疑登革热。在流行地区，手术干预前进行早期登革热抗原检测和腹部影像学检查可能有助于诊断。需要多学科团队参与，根据具体情况做出决策，以提供最佳护理。
