Background Abdominal surgery is one of the most common procedures in a non-elective setting. Especially in the era of the COVID-19 pandemic nowadays, many kinds of abdominal surgery have been rescheduled and we must make priorities of what procedures should be done during the pandemic. Many guidelines (such as Royal College Surgery) suggested to postpone and reschedule the operative treatment during the pandemic, even in gastrointestinal cancer surgery. In this pandemic era, those guidelines could be applied in many elective settings, but not in emergency abdominal surgery procedures, we must face increasing post operative morbidity and mortality on performing surgery in confirmed COVID-19 will evaluate the post operative morbidity which leads to increased mortality of COVID-19 patients whose underwent emergency abdominal surgery during the pandemic.

Methods This study has conducted at Digestive Surgery Division at Moewardi General Hospital, Indonesia, from April 2020 until March 2021. Emergency abdominal surgery, including trauma and non-trauma cases, will be included in this study. All patients have already confirmed with positive COVID-19 pre-operatively. The procedure of this emergency surgery is laparotomy exploration with standardized level 3 PPE during surgery. The exclusion criteria of this study are to redo surgery and pediatric surgery case. The presence of post operative morbidity and in-hospital mortality will be recorded following this study.

Results From April 2020 until March 2021, we reported 39 emergency abdominal surgery cases. All of them have been done emergency exploratory laparotomy. The most common procedure is diffuse peritonitis due to peptic ulcer perforation (reported in 21 cases), other procedures are complicated appendicitis in 9 cases, two cases of blunt abdominal trauma, large bowel obstruction was found in 4 cases and 3 cases of incarcerated groin hernia. Thirty-one patients survived following the emergency abdominal surgery and 8 patients did not survive with post operative pneumonia and uncontrolled sepsis in the ICU.

Conclusions Post operative pneumonia is the important factor which has an impact on unfavorable clinical outcome during emergency abdominal surgery procedures on confirmed COVID-19 positive patients. These high-risk procedures need the perioperative multidiscipline team to gain a better outcome in this current pandemic.