SARS-CoV-2 Pandemic – A Complicated Case of Appendicitis

Figure

a) Axial thoracoabdominal CT in the lung window: confluent subpleural ground-glass opacification in left lower lobe; b) frontal thoracoabdominal CT in the soft-tissue window after intravenous and oral administration of contrast medium: wall thickening of appendix with surrounding fatty tissue imbibition (arrow)

A 21-year-old woman with suspected appendicitis (Alvarado score 5) was assigned to the COVID-positive area of the emergency room because she also reported temperature readings of up to 39.3 ° C, diarrhea, and cold symptoms. Laboratory tests revealed leukocytopenia (3.75/nL). This combination of leukocytopenia and cold symptoms, atypical for appendicitis, prompted consideration of COVID-19, which sometimes features abdominal manifestations. In the absence of a rapid test for SARS-CoV-2, we ordered computed tomography of the chest and abdomen. Imaging detected acute appendicitis accompanied by an infiltrate suggestive of COVID-19. The patient’s respiration was stable, so after weighing up the risks, and with the patient’s consent, we carried out laparoscopic appendectomy. All appropriate precautions were observed. Postoperative extubation was unproblematic and the recovery uncomplicated. The swab taken at arrival later turned out to be positive for COVID-19. Pathological examination revealed ulcerophlegmonous appendicitis. Detection of mild COVID-19 disease is crucial for the prevention of spread to hospital employees and other patients.

Dr. med. Teresa Schreckenbach, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt am Main, [e-mail]

Dr. med. Maximilian Lahrsow, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt am Main

Norbert Fritsch, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt am Main

Reproduced by kind permission of Prof. Vogl, Director of the Institute for Diagnostic and Interventional Radiology, Frankfurt am Main University Hospital

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Schreckenbach T, Lahrsow M, Fritsch N: SARS-CoV-2 pandemic—a complicated case of appendicitis.
Dtsch Arztebl Int 2020; 117: 364. DOI: 10.3238/arztebl.2020.0364