Collateral Damage: The Impact of the COVID-19 Pandemic on Acute Abdominal Emergency Presentations

Abstract

Introduction: In March 2020, the World Health Organization declared a pandemic caused by a novel coronavirus. Public information created awareness as well as concern in the general population. There has been a reported decrease in the number of patients attending emergency departments (ED) during the pandemic. This is the first study to determine differences in the types of presenting illnesses, severity, and rate of resultant surgical intervention during the pandemic.

Methods and materials: We carried out a retrospective, observational cohort study comparing two groups of patients attending the ED at our tertiary-care academic hospital. A historical comparison cohort was obtained by reviewing the number of patients referred by the ED for abdominal CT between March 15 and April 15, 2020, compared with March 15 and April 15, 2019. CT reports were reviewed; primary pathologies, complications, and subsequent surgical intervention were documented and compared between the two groups.

Results: In all, 733 patients were included in the 2019 cohort, and 422 patients were included in the 2020 cohort. In 2019, 32.7% had positive CT findings, increasing to 50.5% in 2020. The number of complications increased from 7.9% to 19.7%. The rate requiring surgical intervention increased from 26.3% to 47.6% in 2020.

Conclusion: To date, there is little published data regarding the presentation and severity of illnesses during the coronavirus disease 2019 pandemic. This information has important public health implications, highlighting the need to educate patients to continue to present to hospital services during such crises, including if a purported second wave of COVID-19 arises.

Keywords: Abdominal; COVID-19; CT; emergency department; pandemic.

Fig 1

(a-c) Axial, coronal, and sagittal contrast-enhanced abdominal CT images from a 43-year-old woman who presented to the emergency department with a 5-day history of lower abdominal pain. The images show a perforated appendicitis with a >1 cm appendicolith in the right lower pelvis. The abscess involves the right adnexa and fallopian tube. The blue arrows show an abscess secondary to a perforated appendicitis with a >1cm appendicolith in the right lower pelvis.

Fig 2

(a-c) Axial, coronal, and sagittal contrast-enhanced abdominal CT images from a 73-year-old woman presenting to emergency department with a 5-day history of lower abdominal pain and constipation. The images demonstrate severe sigmoid diverticulitis with a perforation and large air and fluid collection in the left lower quadrant. The blue arrows demonstrate severe sigmoid diverticulitis with a perforation and large air and fluid collection in the left lower quadrant.

Fig 3

(a, b) Axial and coronal contrast-enhanced abdominal CT images from a 56-year-old man presenting with a 6-day history of increasing abdominal girth, no bowel motion or flatus. The images show an obstructing apple core mass in the sigmoid colon with an associated large bowel obstruction and free fluid. The gas pattern of the caecum is suspicious for ischemia. The blue arrow shows an obstructing apple core mass in the sigmoid colon with an associated large bowel obstruction and free fluid.

Fig 4

(a-c) Axial, coronal, and sagittal contrast-enhanced abdominal CT images from a 73-year-old man presenting with a 3-day history of vomiting and no bowel motions. The images demonstrate a proximal small bowel obstruction and associated perforation. There is an organizing air and fluid collection in the anterior upper abdomen. The blue arrows demonstrate a proximal small bowel obstruction and associated perforation.