The abdomen is a Pandora’s box” is a well-known phrase described by many surgeons around the world. Abdominal pain has always been a tricky symptom to assess. And now, during this lockdown, we are getting a lot more calls from our patients complaining of abdominal symptoms. These may vary from simple gastritis-like pain to acute/severe abdominal pain. These symptoms need to be evaluated and their medical history studied before the diagnosis and appropriate treatment.
Abdominal discomfort has been identified as one of the less common symptoms of the COVID-19 infection. Recent literature has revealed that about 20% of patients report to the hospital with a digestive symptom, such as diarrhoea, vomiting and/or pain, accompanying their respiratory symptoms. And roughly 5% show up with abdominal complaints alone. A study in China found that a third of the people with mild COVID-19 experienced diarrhoea that lasted, on an average, five days. It took them longer to clear the virus from their bodies, compared to those without gastrointestinal symptoms.
So, when should a patient with abdominal symptoms visit a hospital? If the pain or associated symptoms like vomiting, diarrhoea, bloating or fever show an increasing trend over a few hours since the onset, it is better to consult a specialist at the hospital.
Any acute abdominal pain could mean that the patient may have an intestinal obstruction, infection or inflammation of the appendix, gallbladder stones causing infection and pus within the biliary tract, intestinal perforations and more. These signs would be intolerable and will limit regular activity or movement.
How do we diagnose once we see you? It’s a combination of complete history taking and clinical examination with blood tests and radiological tests like USG abdomen or CT abdomen. Once diagnosed, treatment choices are offered which may be medical or surgical in nature. In some situations, emergency surgery may be recommended to avoid further sepsis as this may hamper the overall outcome of the treatment and life of a person.
About 90% of these procedures can be completed by laparoscopy (keyhole surgery) which is a minimally-invasive method of performing surgeries. Most of these patients get discharged within two days and are able to do their routine work soon. When there is a significant delay between onset of symptoms and arrival at the hospital, that is where the chances of performing these procedures through the keyhole method decreases and the rate of complication rises. But during this current situation, I am sure you are probably wondering how safe it is for people to visit the hospital. All hospitals are taking utmost precautions to safeguard the health and safety of their patients and, of course, the healthcare workers. Effective screening of every person, including doctors and staff, is performed as they enter the hospital on a daily basis. All patients are screened and their attenders screened. If anyone has any suspected symptom related to COVID-19, they are isolated and admitted in specialised isolation suites till the test results are out.
All patients undergoing surgery are tested for COVID-19 and all healthcare staff dealing with the patients wear full personal protective equipment while treating or handling these patients, even if the results of tests for COVID-19 are negative. Patients who are recuperating from surgery must take extra precautions as their general immunity will be a bit more compromised.
People must stay at home if they are fine and healthy, eat healthy food and indulge in some form of exercising like walking and breathing exercises within the house to keep themselves fit. Physical distancing is a very important principle to follow during this period but in the case of an abdominal or a gastrointestinal (GI) emergency, healthcare distancing need not be practised. The best outcomes in all these GI emergencies can be fully achieved if the patient reports early to the hospital.
(The author is the Clinical Lead of the Department of Minimal Access and Bariatric Surgery at MGM Healthcare)