Journal of Surgical Simulation 2021; 8: A: 23 - 23
Published: 05 July 2021
Special Issue: Chest imaging and RT-PCR testing for acute abdominal pain during the COVID-19 pandemic
Introduction: Coronavirus disease (COVID-19) has spread rapidly around the world. Challenges about COVID-19 testing were observed in the UK, and difficult decisions regarding operating unknowingly on COVID-19 positive patients were of major concern.
Methods: During the COVID-19 crisis (March-June, 2020), a retrospective study was carried out on 279 patients who presented to the surgical assessment unit at Medway Maritime Hospital with acute abdominal pain. A computed tomography (CT) scan of the abdomen and pelvis (CTAP) was performed on 215 patients, chest CT scans were included with the CTAP in 17 patients, and chest radiographs were performed on 54 patients. COVID-19 swab RNA tests (RT-PCR) were performed on 80 patients.
Results: Forty three patients required urgent abdominal operations among those who had CTAP. RT-PCR was positive for COVID-19 among 3 of 80 patients who had the test. CT chest scans were performed on 17 patients, four of whom showed ground glass opacities typical of COVID-19, but RTP-CR revealed negative results for all of them. Furthermore, 13 out of 54 patients had shadowing on chest radiographs, but only one of them with consolidation was TR-PCR positive and fortunately did not require surgical intervention. The second RT-PCR positive patient (with normal CT chest scan and clear chest radiograph) was not operated upon and was treated conservatively. The third RT-PCR positive patient who had a normal chest radiograph and was operated on without knowing they were COVID-19 positive.
Conclusion: The risk of operating during an emergency on unknown COVID-19 positive patients is a real one. Investigations such as CT chest or chest radiograph are of uncertain value in the identification of these patients. COVID-19 RT-PCR results are usually delayed. Therefore, a more informative panel of COVID-19 revealing investigations are required to aid in the surgical decision to take patients to theatre.
COVID-19; chest imaging; RT-PCR; surgical assessment; abdominal pain
This presentation was given at the SES 2020 online conference, 4 July 2020.