In Japan, 1.7 million patients were infected with COVID-19 from the first to the fifth wave (from March 2020 to December 2021). The prevalence of anorexia, nausea/vomiting, diarrhea and abdominal pain with COVID-19 was reported to be 21 to 34.8%, 7 to 26.4%, 9 to 33.7% and 1.9 to 14.5%, respectively. The incidence of gastrointestinal symptoms with COVID-19 was reported to range from 3 to 61%. Moreover, COVID-19 is widely known to also induce a variety of extrapulmonary manifestations, with gastrointestinal manifestations being the most common of them. The typical clinical symptoms of patients with mild COVID-19 are fever, cough, dyspnea and myalgia or fatigue. The clinical course ranges from asymptomatic to critically ill, and approximately 5–20% of patients with COVID-19 develop severe pneumonitis, with some progressing to life-threatening respiratory failure, acute respiratory distress syndrome, multiple organ failure and various other pathological conditions. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China, as the cause of a respiratory illness designated coronavirus disease 2019 (COVID-19). When examining patients with mild COVID-19 with gastrointestinal bleeding, the potential for acute hemorrhagic colitis should be kept in mind. Our study showed that acute hemorrhagic colitis was characteristic in mild cases of the omicron variant of COVID-19 with gastrointestinal bleeding. The localization of acute hemorrhagic colitis was the left-sided colon in all cases. Of these patients, 17 were diagnosed as having acute hemorrhagic colitis, five had drug-induced adverse events, two had retroperitoneal hemorrhage, two had appendicitis, two had choledocholithiasis, two had constipation, and two had anuresis, among others. The number of patients with each abdominal symptom were as follows: nausea and vomiting (86/183, 47%), abdominal pain (63/183, 34%), diarrhea (61/183, 33%), gastrointestinal bleeding (20/183, 11%) and anorexia (6/183, 3.3%). ResultsĪbdominal symptoms were present in 183 patients with COVID-19. Data collected included diagnostic characteristics, abdominal symptoms, extra-abdominal symptoms and complicated diagnosis other than that of COVID-19 for abdominal symptoms. We collected and described physical examination results, medical history, laboratory data, computed tomography findings and treatments. Patients delivered by ambulance or transferred from other hospitals were not included. In total, 2291 consecutive patients with COVID-19 who visited the Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, Osaka, Japan, between January 2022 and September 2022 were potentially eligible for the study. This study was a retrospective, single-center, descriptive study. The aim of our study was to clarify the diagnosis of concomitant abdominal diseases in patients with mild COVID-19 who presented to hospital with abdominal symptoms during the sixth and seventh waves of the pandemic of the omicron variant in Japan. Although previous reports have addressed abdominal complications with COVID-19, these have not been adequately elucidated for the omicron variant. Gastrointestinal symptoms have been identified as the most common extra-pulmonary manifestations of COVID-19, with an incidence reported to range from 3 to 61%. COVID-19 is widely known to induce a variety of extrapulmonary manifestations.
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