P56 Gastrointestinal manifestations of COVID-19: a retrospective analysis

INTRODUCTION: Emerging data suggests that SARS-CoV-2 acts via the angiotensin-converting-enzyme-2 (ACE2) receptors in the cells, also present in the gastrointestinal and liver cells, resulting in gastrointestinal manifestations of COVID-19. It is challenging to diagnose COVID-19 in patients presenting with only gastrointestinal symptoms, with early suspicion and visualisation of the lung bases on computerised tomography(CT) abdomen scans being helpful. METHODS: Single-centre retrospective analysis of abdominal/chest CT scans was conducted within a District General Hospital. From the 6000 CT scans between March and April 2020, 1557(26%) were abdominal, 230 of which had chest CT scans with COVID-19 positive changes. 49 patients with CT abdomen and a positive CT Chest were shortlisted. All recorded documentation was assessed using online clinical portal and tabulated using Microsoft Excel®. Subdivision into 3 groups was: 1) primary gastrointestinal symptom, normal CT abdomen, 2) common COVID-19 symptoms with gastrointestinal symptoms, normal CT abdomen 3) gastrointestinal symptoms, abdominal pathology on radiology. RESULTS: COVID-19 related changes were seen on CT scans with no abdominal pathology noted in 33% (n = 16) patients with primary gastrointestinal symptoms. Further 18% (9 patients) presented with gastrointestinal symptoms alongside other common COVID-19 symptoms, however abdominal CT scan was normal. CT abdomen of these 25 patients were studied by a consultant radiologist, who examined the lung bases on the abdominal CT scan for COVID-19 related changes, which was seen in 92% patients. In 8% of the cases where the lung bases on the CT abdomen were normal, COVID-19 related changes were apparent on the CT chest. CONCLUSIONS: CT scans of the abdomen should be supplemented with CT scans of the chest, when appropriate, for early accurate diagnosis, early treatment and triage to the correct wards, especially at the height of the pandemic.