About the scientific letter ‘Suspected acute abdomen as an extrapulmonary manifestation of COVID-19 infection’

To the Editor

We have read the article published in this journal by R. Blanco-Colino et al¹ about COVID-19 and its manifestation in the form of acute abdomen. Given the current pandemic situation we are in, we surgeons have been able to work as a team with different specialties and update our knowledge in different fields that we are not accustomed to. Much of the knowledge gained regarding the management of COVID-19 has unfortunately been improvised initially, and then later based on protocols that have been changed relatively frequently.

As, reported by the authors, it is known that an important percentage of COVID-19–positive patients present gastrointestinal symptoms, including anorexia, diarrhea, vomiting². However, it is true that the vast majority are accompanied by respiratory symptoms or fever, COVID- rarely presents as, an isolated gastrointestinal symptom³. Both manifestations can coexist without being dependent on one another. We must not forget that gastrointestinal symptoms were already described during the SARS outbreak in 2003⁴, so even though it is considered a new pandemic, we already had information available.

The title of the article can be misinterpreted if we understand acute abdomen to be sudden and intense abdominal pain that requires urgent medical or surgical action⁵. The authors’ description of the clinical case does not fit this definition or standard practice. The etiological diagnosis of infectious colitis requires different diagnostic tests (stool culture, histological study, immunohistochemistry, etc) based on clinical suspicion^6,7. With the data providedin the case description and with the abdominal x-ray (see legend of Figure 1), such a diagnosis cannot be made. If suspected, we did not find the intention to perform any of the aforementioned diagnostic tests. Likewise, different concepts, such as lymphopenia or altered liver levels (in patients already treated) are introduced that are not related to the purpose of the article: to alert us to the alleged gastrointestinal manifestations caused by COVID-19.

Given that we do not know the absolute number of the infected population and that the estimates suggest they are more cases than reported, it is logical to suspect that many of the patients we treat for other reasons will be COVID-19–positive. We feel it is positive that the authors highlight the need to conduct a thorough anamnesis about respiratory symptoms in order for precautions and isolation measures to be taken. However, regardless of the pandemic, a complete patient medical history should be compulsory for any surgeon.

In unknown scenarios, the reporting of clinical cases may be of general interest, but publishing practically everything related to COVID-19 can cause confusion, especially when the information does not provide solutions. As of today, four months after the initial outbreak, interactions and exchange of information between surgeons on social media is immediate; surveys and coordinated studies are being conducted among different surgery groups, which are of greater help and are more informative.