Article The American Surgeon 2022, Vol. 0(0) 1–7 © The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/00031348221114033 journals.sagepub.com/home/asu COVID-19 Diagnosis in Patients With Acute Abdominal Pain Without Respiratory Symptoms: A UK Emergency General Surgical Unit Experience Sharukh Zuberi, MRCS 1 , Yusuf Mushtaq, MB BChir 1 , Krashna Patel, MSc FRCS 1 , Saranya Vickramarajah, FRCR 2 , Alan Askari, PhD MSc FRCS 1 , Farhan Rashid, MD FRCS 1 , and Roy Gurprashad, MSc FRCS 1 Abstract Background: Recent evidence has emerged reporting atypical clinical symptoms of the novel coronavirus (COVID-19). There is a sparsity of existing studies examining COVID-19-related abdominal pain and the role of investigative imaging for the virus in these patients. Study aims were to determine COVID-19 incidence in those with acute abdominal pain in the absence of respiratory symptoms and to assess the diagnostic performance of CT thoracic imaging in such patients. Methods: Retrospective analysis of all consecutive patients admitted to our emergency general surgical unit between 1 st March 2020 and 31 st May 2020 was performed. In adherence with national guidelines, all patients underwent nasal and oro-pharyngeal COVID-19 RT-PCR swabs as well as thoracic and abdominal computed tomography (CT) on admission. Results: From 112 patients admitted with acute abdominal pain in the absence of respiratory symptoms, 16 (14.3%) tested positive for COVID-19 on RT-PCR swab testing. Overall, 50% (8/16) of these patients had no intra-abdominal pathology on CT. The sensitivity and specificity of CT thoracic imaging for diagnosing COVID-19 was 43.8% and 91.7%, respectively. Patients with positive COVID-19 swabs had higher C-reactive protein levels, lower potassium levels and a higher proportion of those with a low lymphocyte count. Discussion: One in seven patients with abdominal pain without any respiratory symptoms tested positive for COVID- 19. Half of these patients represented COVID-19 manifesting primarily as acute abdominal pain. Combined swab testing and CT imaging should be performed in all abdominal pain presentations due to the varying diagnostic performance of thoracic CT in diagnosing COVID-19. Keywords COVID-19, general surgery, radiology Key Takeaways · This study examined a surgical patient population presenting to our unit with acute abdominal pain without the typical respiratory symptoms usually associated with COVID-19. · We report a 14.3% (16/112) incidence of COVID- 19 in this population. Half of these patients (8/16) had normal abdominal CT findings, suggesting COVID-19 was potentially presenting primarily with abdominal pain. · Our secondary aims also assessed the diagnostic performance of thoracic CT in diagnosing COVID-19 (by demonstrated typical COVID-19 CT changes) in this cohort of surgical patients presenting with ab- dominal pain in the absence of respiratory symptoms. 1 Department of General Surgery, Luton & Dunstable University Hospital, Luton, UK 2 Department of Radiology, The Royal London Hospital, Whitechapel, London Corresponding Author: Sharukh Zuberi, MRCS, Luton & Dunstable University Hospital, Lewsey Road, Luton, Bedfordshire, LU4 0DZ, London. Email: sharukh.zuberi@nhs.net