Patel Maitreyi S, Jebamani Jennifer S, Das Mohapatra Shrabani
General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, GBR.
Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, GBR.
Cureus. 2021 Oct 27;13(10):e19073. doi: 10.7759/cureus.19073. eCollection 2021 Oct.
Aims COVID-19 can present with abdominal pain and affects the management of emergency surgical patients. The aim of this retrospective study was to assess the incidence of positive findings on CT chest in patients presenting with acute abdomen, who underwent CT thorax as part of the Intercollegiate General Surgical Guidance on COVID-19 during the first wave. To correlate CT chest findings with confirmed cases on reverse transcription polymerase chain reaction (RT-PCR), and to determine its influence on surgical management of abdominal emergencies. Methods A retrospective observational study of adult emergency surgical referrals (excluding trauma) for acute abdomen over a 10-week period was performed. COVID-19 changes on CT chest were categorized as per the British Society of Thoracic Imaging (BSTI) CT reporting criteria. Patient demographics, COVID-19 RT-PCR, management and outcome were recorded. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, USA) with p-value significant at ≤0.05. Results Of the 160 patients included, 111 (69.38%) had COVID-19 RT-PCR. Twenty-four patients had CT chest findings suggestive of COVID-19. Amongst these, 45.83% demonstrated classic/probable CT features of COVID-19, of which 36.36% had positive RT-PCR. Most patients who had acute abdominal findings had a normal CT chest (p=0.03). Twenty-five (15.63%) patients presenting with abdominal pain had normal CT abdomen and seven (28%) of these had CT features of COVID-19. Only 43 (34.4%) patients needed a surgical intervention, of which 18.6% had COVID-19 changes on CT, confirmed by positive RT-PCR in 12.5%. Conclusion CT chest is an important investigation during the COVID-19 pandemic in suspected cases to help assess the severity of lung involvement. CT chest as an additional investigation modality in acute abdomen had clinically helped in triaging of patients to appropriate specialties but did not influence emergency surgical management.
新型冠状病毒肺炎（COVID-19）可表现为腹痛，并影响急诊外科患者的治疗。本回顾性研究的目的是评估在第一波疫情期间，因急性腹痛就诊并接受胸部CT检查的患者中，胸部CT阳性结果的发生率。这些胸部CT检查是作为跨学院普通外科COVID-19指南的一部分进行的。将胸部CT结果与逆转录聚合酶链反应（RT-PCR）确诊病例相关联，并确定其对腹部急症手术治疗的影响。方法：对10周内因急性腹痛就诊的成年急诊外科转诊患者（不包括创伤患者）进行回顾性观察研究。根据英国胸科影像学会（BSTI）的CT报告标准，对胸部CT上的COVID-19改变进行分类。记录患者的人口统计学资料、COVID-19 RT-PCR结果、治疗情况及结局。使用Microsoft Excel（美国微软公司，雷德蒙德）进行统计分析，p值≤0.05具有统计学意义。结果：纳入的160例患者中，111例（69.38%）进行了COVID-19 RT-PCR检测。24例患者的胸部CT表现提示COVID-19。其中，45.83%表现出COVID-19的典型/可能CT特征，其中36.36%的RT-PCR结果为阳性。大多数有急性腹部表现的患者胸部CT正常（p=0.03）。25例（15.63%）腹痛患者腹部CT正常，其中7例（28%）有COVID-19的CT特征。仅43例（34.4%）患者需要手术干预，其中18.6%的患者胸部CT有COVID-19改变，12.5%经RT-PCR阳性确诊。结论：在COVID-19大流行期间，胸部CT是疑似病例的一项重要检查，有助于评估肺部受累的严重程度。胸部CT作为急性腹痛的一项额外检查手段，在临床上有助于将患者分诊到合适的专科，但不影响急诊手术治疗。
