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DENGUE HEMORRHAGIC FEVER PATIENTS WITH ACUTE ABDOMEN: CLINICAL EXPERIENCE OF 14 CASES

Among 328 patients with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 14 (4 men and 10 women, median age 44 years) had acute abdomen. DHF/DSS was initially suspected in only 2 of these 14 patients. Presumptive diagnoses of acute cholecystitis (6 acalculus and 4 calculus cholecystitis) were made in 10 patients, non-specific peritonitis in three patients, and acute appendicitis in one patients. Cholecystectomy, percutaneous transhepatic gallbladder drainage, and appendectomy were performed in three patients. Transfused blood in the three patients who underwent invasive procedures and the 11 patients who received supportive treatment included packed red blood cells (24 versus 0 units; P = 0.048), fresh frozen plasma (84 versus 0 units; P = 0.048), and platelets (192 versus 180 units; P = 0.003). Patients who underwent invasive procedures also had prolonged time in the hospital (median = 11 versus 7 days; P = 0.015). To avoid unnecessary invasive procedure–related morbidity and mortality, this report underscores the importance of a careful differential diagnosis in patients with acute abdomen in a dengue-endemic setting.

Received April 9, 2005. Accepted for publication November 8, 2005.

^* Address correspondence to Jien-Wei Liu, Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan, Republic of China. E-mail: 88b0{at}adm.cgmh.org.tw

Authors’ addresses: Boon-Siang Khor, Department of Emergency and Critical Medicine, Li-Shin Hospital, Ping-Chen, Taoyuan, Taiwan, Republic of China. Jien-Wei Liu and Ing-Kit Lee, Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and School of Medicine, Chang Gung University Taiwan, Kweishan, Taoyuan, Taiwan, Republic of China. Kuender D. Yang, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan, Republic of China.

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