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Acute abdomen is not always surgical amid the COVID‐19 pandemic
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COVID‐19 related‐non‐surgical causes of acute abdomen
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Editor
Lima et al.'s recently published paper discussed the role of imaging in the diagnosis of acute abdomen cases amid the COVID‐19 era 1 . Saeed et al. reported that SARS‐CoV‐2 infection could lead to an acute abdomen‐like presentation in the absence of identifiable surgical causes 2 . Both authors discussed the role of angiotensin‐converting‐enzyme‐2 (ACE2) receptor in the pathogenesis of this entity. Our experience with similar cases makes us concur with both authors 3 . Herein we will summarize the likely non‐surgical causes of acute abdomen in the COVID‐19 era and discuss important management points when dealing with such patients.
The causes can be divided into respiratory and non‐respiratory (Fig. 1 ). A respiratory cause for such presentation is pain referring from lower lungs involved by the SARS‐CoV‐2. The SARS‐CoV2 infection seems to increase the risk of thrombosis 4 ; thus, the non‐respiratory causes can be further classified as thrombotic and non‐thrombotic. Non‐thrombotic causes include pancreatitis, peritonitis, colonic distension, and colitis, while thrombotic etiologies are mesenteric vessel ischemia (occlusive or non‐occlusive), renal vessels infarcts, appendagitis, and omental infarcts (Fig. 1 ).
Fig. 1 COVID‐19‐related non‐surgical causes of acute abdomen With the causes mentioned above in mind, it is wise to keep a broad differential of non‐surgical causes of acute abdomen in the setting of SARS‐CoV‐2 infection, to avoid unnecessary surgical interventions 5 . Any patients presenting with an acute abdomen should be tested and retested for SRAS‐CoV‐2, even in the absence of respiratory symptoms. Elevated serum ferritin may support COVID‐19 diagnosis 3 . Computed tomography (CT) scan of the abdomen and lower chest will be valuable in ruling some of the causes and identifying pulmonary involvement. If unrevealing, we suggest performing a CT angiogram of the abdomen, focusing on mesenteric and renal vessels. We believe in the role of multidisciplinary meetings (MDT), including radiologists, surgeons, internists, and infectious experts, to tailor an individualized, case‐by‐case management approach.
Author's contribution
MFHM and KA contributed equally to this letter. KA and MFHM wrote the initial and the final version and approved it for submission.
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Editor
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Lima et al.'s recently published paper discussed the role of imaging in the diagnosis of acute abdomen cases amid the COVID‐19 era 1 . Saeed et al. reported that SARS‐CoV‐2 infection could lead to an acute abdomen‐like presentation in the absence of identifiable surgical causes 2 . Both authors discussed the role of angiotensin‐converting‐enzyme‐2 (ACE2) receptor in the pathogenesis of this entity. Our experience with similar cases makes us concur with both authors 3 . Herein we will summarize the likely non‐surgical causes of acute abdomen in the COVID‐19 era and discuss important management points when dealing with such patients.
The causes can be divided into respiratory and non‐respiratory (Fig. 1 ). A respiratory cause for such presentation is pain referring from lower lungs involved by the SARS‐CoV‐2. The SARS‐CoV2 infection seems to increase the risk of thrombosis 4 ; thus, the non‐respiratory causes can be further classified as thrombotic and non‐thrombotic. Non‐thrombotic causes include pancreatitis, peritonitis, colonic distension, and colitis, while thrombotic etiologies are mesenteric vessel ischemia (occlusive or non‐occlusive), renal vessels infarcts, appendagitis, and omental infarcts (Fig. 1 ).
Fig. 1 COVID‐19‐related non‐surgical causes of acute abdomen With the causes mentioned above in mind, it is wise to keep a broad differential of non‐surgical causes of acute abdomen in the setting of SARS‐CoV‐2 infection, to avoid unnecessary surgical interventions 5 . Any patients presenting with an acute abdomen should be tested and retested for SRAS‐CoV‐2, even in the absence of respiratory symptoms. Elevated serum ferritin may support COVID‐19 diagnosis 3 . Computed tomography (CT) scan of the abdomen and lower chest will be valuable in ruling some of the causes and identifying pulmonary involvement. If unrevealing, we suggest performing a CT angiogram of the abdomen, focusing on mesenteric and renal vessels. We believe in the role of multidisciplinary meetings (MDT), including radiologists, surgeons, internists, and infectious experts, to tailor an individualized, case‐by‐case management approach.
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Lima et al.'s recently published paper discussed the role of imaging in the diagnosis of acute abdomen cases amid the COVID‐19 era 1 . Saeed et al. reported that SARS‐CoV‐2 infection could lead to an acute abdomen‐like presentation in the absence of identifiable surgical causes 2 . Both authors discussed the role of angiotensin‐converting‐enzyme‐2 (ACE2) receptor in the pathogenesis of this entity. Our experience with similar cases makes us concur with both authors 3 . Herein we will summarize the likely non‐surgical causes of acute abdomen in the COVID‐19 era and discuss important management points when dealing with such patients.
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p
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The causes can be divided into respiratory and non‐respiratory (Fig. 1 ). A respiratory cause for such presentation is pain referring from lower lungs involved by the SARS‐CoV‐2. The SARS‐CoV2 infection seems to increase the risk of thrombosis 4 ; thus, the non‐respiratory causes can be further classified as thrombotic and non‐thrombotic. Non‐thrombotic causes include pancreatitis, peritonitis, colonic distension, and colitis, while thrombotic etiologies are mesenteric vessel ischemia (occlusive or non‐occlusive), renal vessels infarcts, appendagitis, and omental infarcts (Fig. 1 ).
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Fig. 1 COVID‐19‐related non‐surgical causes of acute abdomen
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COVID‐19‐related non‐surgical causes of acute abdomen
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COVID‐19‐related non‐surgical causes of acute abdomen
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With the causes mentioned above in mind, it is wise to keep a broad differential of non‐surgical causes of acute abdomen in the setting of SARS‐CoV‐2 infection, to avoid unnecessary surgical interventions 5 . Any patients presenting with an acute abdomen should be tested and retested for SRAS‐CoV‐2, even in the absence of respiratory symptoms. Elevated serum ferritin may support COVID‐19 diagnosis 3 . Computed tomography (CT) scan of the abdomen and lower chest will be valuable in ruling some of the causes and identifying pulmonary involvement. If unrevealing, we suggest performing a CT angiogram of the abdomen, focusing on mesenteric and renal vessels. We believe in the role of multidisciplinary meetings (MDT), including radiologists, surgeons, internists, and infectious experts, to tailor an individualized, case‐by‐case management approach.
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Author's contribution
MFHM and KA contributed equally to this letter. KA and MFHM wrote the initial and the final version and approved it for submission.
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title
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Author's contribution
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MFHM and KA contributed equally to this letter. KA and MFHM wrote the initial and the final version and approved it for submission.
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Acknowledgement
We acknowledge the editor and the editorial team members for their prompt review of the letter.
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Acknowledgement
We acknowledge the editor and the editorial team members for their prompt review of the letter.
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Acknowledgement
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We acknowledge the editor and the editorial team members for their prompt review of the letter.
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