Publication:

Surgical presentations with abdominal pain in dengue fever

Background Dengue Fever (DF) is a tropical disease caused by single stranded RNA flavivirus that is transmitted by the bite of female Aedes aegypti mosquito. The objective of this study was to ascertain different etiologies for abdominal pain in dengue fever with their respective incidence and their management.

Methods Patients admitted with dengue fever (confirmed by ELISA or NS1Ag) with pain abdomen in our hospital were included in the study. The cause of pain abdomen ascertained clinically and by following tests: Pancreatitis - amylase, lipase, USG, CECT, Hepatitis-liver function test, Hollow viscous perforation Erect X-ray abdomen, Cholecystitis-USG, Appendicitis-TLC, USG.

Results Out of total cases (n=214) included into the study features of acalculous cholecystitis were seen in 122 (58%) patients, pancreatitis in 24 (11.5 %), appendicitis in 4 (1.9 %), hepatitis: 27 (12.9 %) non-specific in 33 (15.7 %) patients. All of the patients were managed conservatively and regularly followed up till they became asymptomatic. None of the patients required any surgical intervention. All the patients responded well to conservative line of management and were discharged.

Conclusions Abdominal pain developing in dengue patients mimics many of surgical emergencies like cholecystitis, appendicitis, hepatitis, and pancreatitis. Most of these patients respond well to conservative line of management with I.V fluids, antibiotics, analgesics without the need for any surgical intervention. Hastily taken decisions with operative management for such patients have led to serious consequences in the past. Our study supports conservative line of management in such scenarios and advocates avoidance of surgical option. Our study also throws light on the various modes of presentations, with their respective percentages.