Case series of acute appendicitis association with SARS-CoV-2 infection

Charlsea Prichard,William Parker,Kindra Mcwilliam-Ross,John Birbari,John W Hollingsworth,Matthew Canning,Lori Wasson

doi:10.1186/s12879-021-05909-y

Abstract

BackgroundDescribe the indications for surgical interventions in asymptomatic patients with SARS-CoV-2. We are unaware of previous reports of an association between SARS-CoV-2 and acute appendicitis.MethodsWe performed a single institution retrospective review of SARS-CoV-2 pre-procedure testing and indications for surgical intervention. Statistical comparisons were performed using Chi Square analysis or two-tailed Student T test.ResultsWe report a high prevalence of SARS-CoV-2 in both all testing and pre-procedure testing during the enrollment period. We observe a high prevalence of acute appendicitis among patients identified to be SARS-CoV-2 positive during pre-procedure testing and without recognized symptoms of COVID19.ConclusionWe report a previously unrecognized association between SARS-CoV-2 and acute appendicitis.

Highlights

Describe the indications for surgical interventions in asymptomatic patients with SARS-CoV-2
Our hospital has adopted a protocol to test all patients prior to invasive procedures. This strategy provides some insight into the community prevalence of asymptomatic disease as these patients did not present with typical symptoms of coronavirus disease 2019 (COVID19). ln recent weeks, we observed an increase in percentage of positive SARS-CoV2 tests prior to procedures
We identified through preprocedure SARS-CoV-2 testing that a diagnosis of acute appendicitis is much more likely to be positive for SARS-CoV-2, when compared to all other patients presenting for interventional procedures (10.8% vs 1.3%; p < 0.001)

Summary

Introduction

Describe the indications for surgical interventions in asymptomatic patients with SARS-CoV-2. We observe a high prevalence of acute appendicitis among patients identified to be SARS-CoV-2 positive during pre-procedure testing and without recognized symptoms of COVID19. SARS-Cov-2 pandemic has been reported to impact management of acute appendicitis with possibly fewer cases presenting to the hospital [4], a delay the time of diagnosis, increased frequently peritonitis [5] and more severe septic abdominal diseases [6]. It is recognized that patients with asymptomatic SARS-CoV-2 infection undergoing elective surgeries experience both respiratory-related complications and high mortality [7]. We report our observations supporting an association between acute appendicitis and SARS-CoV-2

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Discussion

Conclusion