Abdominal Pain as First Manifestation of New Coronavirus Infection COVID-19
https://doi.org/10.22416/1382-4376-2020-30-6-57-62
Abstract
Aim. A clinical case description of abdominal pain as the first manifestation of the new coronavirus infection COVID-19.
Key points. A 80-yo patient was admitted to a surgical unit with growing epigastric pain and fever. Acute abdomen was diagnosed negative, chest computed tomography (CT) revealed two-sided ground-glass opacity, discharged. Hospitalised in a severe condition with presumed new coronavirus infection at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, the Sechenov University. COVID-19 agent RNA was detected with PCR. Diagnosis: new coronavirus infection COVID-19, severe degree, community-acquired bilateral polysegmental pneumonia, severe degree, respiratory failure type 1. Therapy with azithromycin, hydroxychloroquine, enoxaparin subcutaneously. Respiratory distress increased on day 7 at the clinic, with 50–75% lesion in chest CT, which required ordering of dexamethasone intravenously, with a subsequent dose reduction and withdrawal, and levofloxacin. Upon the treatment, abdominal pain was eliminated, body temperature normalised and the volume of affected parenchyma decreased. The patient was discharged for outpatient care. Patients with SARS-CoV-2 may have abdominal complaints that may require exclusion of an acute surgical pathology. These circumstances inevitably waste time of assisting patients suffering the new coronavirus infection and worsen the prognosis due to severe pneumonia.
Conclusion. A gastroenterological debut of the new coronavirus infection with the main symptoms of abdominal pain has been presented. The currently continued unfavourable epidemiological situation demands diagnosis for SARSCoV-2 and COVID-19-associated pneumonia upon the exclusion of peritoneal symptoms even in absence of respiratory complaints.
Key points. A 80-yo patient was admitted to a surgical unit with growing epigastric pain and fever. Acute abdomen was diagnosed negative, chest computed tomography (CT) revealed two-sided ground-glass opacity, discharged. Hospitalised in a severe condition with presumed new coronavirus infection at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology, the Sechenov University. COVID-19 agent RNA was detected with PCR. Diagnosis: new coronavirus infection COVID-19, severe degree, community-acquired bilateral polysegmental pneumonia, severe degree, respiratory failure type 1. Therapy with azithromycin, hydroxychloroquine, enoxaparin subcutaneously. Respiratory distress increased on day 7 at the clinic, with 50–75% lesion in chest CT, which required ordering of dexamethasone intravenously, with a subsequent dose reduction and withdrawal, and levofloxacin. Upon the treatment, abdominal pain was eliminated, body temperature normalised and the volume of affected parenchyma decreased. The patient was discharged for outpatient care. Patients with SARS-CoV-2 may have abdominal complaints that may require exclusion of an acute surgical pathology. These circumstances inevitably waste time of assisting patients suffering the new coronavirus infection and worsen the prognosis due to severe pneumonia.
Conclusion. A gastroenterological debut of the new coronavirus infection with the main symptoms of abdominal pain has been presented. The currently continued unfavourable epidemiological situation demands diagnosis for SARSCoV-2 and COVID-19-associated pneumonia upon the exclusion of peritoneal symptoms even in absence of respiratory complaints.
About the Authors
M. R. Skhirtladze
Sechenov First Moscow State University (Sechenov University)
Russian Federation
Russian Federation
Manana R. Skhirtladze — Cand. Sci. (Med.), Head of the Department of Cardiology, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology
119435, Moscow, Pogodinskaya str., 1, bld. 1
A. A. Timofeeva
Sechenov First Moscow State University (Sechenov University)
Russian Federation
Russian Federation
Anastasiya A. Timofeeva — Cardiologist, Department of Cardiology, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology
119435, Moscow, Pogodinskaya str., 1, bld. 1
E. L. Bueverova
Sechenov First Moscow State University (Sechenov University)
Russian Federation
Russian Federation
Elena L. Bueverova — Cand. Sci. (Med.), Research Assistant, Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sklifosovsky Institute of Clinical Medicine
119435, Moscow, Pogodinskaya str., 1, bld. 1
M. N. Aladin
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Mark N. Aladin — Clinical Resident
125993, Moscow, Barrikadnaya str., 2/1, bld. 1
R. T. Rzayev
Sechenov First Moscow State University (Sechenov University)
Russian Federation
Russian Federation
Ramin T. Rzayev — Cand. Sci. (Med.), Physician (X-ray), Department of X-ray Diagnostics, University Clinical Hospital No. 3
119435, Moscow, Pogodinskaya str., 1, bld. 1
References
1. Temporary guidelines “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)” (In Russ.)]. URL: rosminzdrav.ru/ministry/med_covid19.
2. Ivashkin V.T., Sheptulin A.A., Zolnikova O.Yu., Okhlobystin A.V., Poluektova E.A., Trukhmanov A.S., et al. New Coronavirus Infection (COVID-19) and Digestive System. Rus J Gastroenterol Hepatol Coloproctol. 2020;30(3):7–13. (In Russ.). DOI: 10.22416/1382-4376-2020-30-3-7
3. Xu H., Zhong L., Deng J., Peng J., Dan H., Zeng X., et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8. DOI: 10.1038/s41368-020-0074-x
4. Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831–33. DOI: 10.1053/j.gastro.2020.02.055
5. Lin L., Jiang X., Zhang Z., Huang S., Zhang Z., Fang Z., et al. Gastrointestinal symptoms of 95 cases with SARSCoV-2 infection. Gut. 2020;69(6):997–1001. DOI: 10.1136/gutjnl-2020-321013
6. Zhang J., Dong X., Cao Y., Yuan Y., Yang Y., Yan Y., et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75:1730–41. DOI: 10.1111/all.14238
7. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. DOI: 10.1001/jama.2020.1585
8. Poggiali E., Ramos P., Bastoni D., Vercelli A., Magnacavallo A. Abdominal Pain: A Real Challenge in Novel COVID-19 Infection. Eur J Case Rep Intern Med. 2020;7(4):001632. DOI: 10.12890/2020_001632
9. Pan L., Mu M., Yang P., Sun Y., Wang R., Yan J., et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;115(5):766–73. DOI: 10.14309/ajg.0000000000000620
10. Saeed U., Sellevoll H.B., Young V.S., Sandbaek G., Glomsaker T., Mala T. Covid-19 may present with acute abdominal pain. Br J Surg. 2020;107(7):e186–7. DOI: 10.1002/bjs.11674
11. Spinelli A., Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg. 2020;107(7):785–7. DOI: 10.1002/bjs.11627
Review
For citations:
Skhirtladze M.R., Timofeeva A.A., Bueverova E.L., Aladin M.N., Rzayev R.T. Abdominal Pain as First Manifestation of New Coronavirus Infection COVID-19. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(6):57-62. (In Russ.) https://doi.org/10.22416/1382-4376-2020-30-6-57-62
Views:
89037
Email this article 
