Covid-19 mimicking symptoms in emergency gastrointestinal su
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-Digestive surgery emergency cases can present with COVID-19 mimicking symptoms

-Indications of emergency surgery are the same in during pandemic compared to non-pandemic settings

-Strict screening, examination, and protocol are necessary during the pandemic

A 75-year-old man was admitted to emergency department with fever, cough, and abdominal pain. The patient had history of diabetes and gastritis diagnosed and treated by gastroenterologist, smoking history, and routinely used analgesics in a recent three consecutive years span. Ronchi and peritoneal signs were found in his physical examination. Laboratory results showed haemoglobin level of 12.5 g/dL, leucocyte count 11.6×109/L, neutrophils 79.3%, lymphocytes 14.0%, and Neutrophils-Lymphocytes Ratio (NLR) 5.66. Both Anti-SARS-CoV-2 IgG and IgM Rapid Test showed non-reactive results. Chest X-Rays showed bronchopneumonia (Fig. 1a) and chest computed tomography (CT)-scan showed emphysematous lungs (Fig. 1b). Abdominal X-Ray showed pneumoperitoneum (Fig. 1c) and abdominal ultrasonography showed subhepatic and Morison pouch free of fluid.

The patient was diagnosed with peritonitis because of hollow organ perforation with bronchopneumonia. The patient underwent exploratory laparotomy with level 3 personal protective equipment. Intraoperative finding was gastric (antrum) perforation, and omental patch was performed to close the defect (Fig. 1d). The patient was treated for two days in the intensive care unit after the surgery and moved to the general ward with stable condition. The COVID-19 PCR test with nasopharyngeal swab sample showed negative results and the pathologic finding showed helicobacter pylori infection. The patient was discharged after 7 days and followed-up weekly. After 3 weeks of follow-up the patient showed no symptoms of fever nor cough. There was minimal surgical site infection which was resolved after topical wound care.

Emergency surgery, especially digestive surgery cases, can be done in the COVID-19 pandemic era with strict prior screening and examination, and safety protocol.