Atypical Presentation of Appendicitis Revealing a COVID-19 Infection

Main Article Content

Fakhar Shahid
Khalid Ahmed
Zubair Shahid
. Inamullah
Syed Muhammad Ali
Zia Aftab

Abstract

COVID-19 can present in many ways that need to be recognized early, to protect the medical staff from exposure/infection, by isolation of affected patients. We report a case, who presented with acute abdominal pain and on investigations was found to have features of acute appendicitis, without any pulmonary symptoms, and tested positive for COVID-19. He was treated conservatively for appendicitis with antibiotics and recovered well but developed full blown COVID-19 pneumonia after three days. This report signifies that COVID-19 infections may present as acute abdominal pain and appendicitis, in our case, the screening protocol helped us to identify this patient and helped to avoid exposure and possible infection to healthcare staff and avoidance of presumably unnecessary appendectomy. 

Keywords:
COVID-19, abdominal pain, atypical presentation, appendicitis.

Article Details

How to Cite
Shahid, F., Ahmed, K., Shahid, Z., Inamullah, ., Ali, S. M., & Aftab, Z. (2020). Atypical Presentation of Appendicitis Revealing a COVID-19 Infection. Asian Journal of Case Reports in Surgery, 5(1), 6-10. Retrieved from https://journalajcrs.com/index.php/AJCRS/article/view/30153
Section
Case Study

References

Gahide G, Frandon J, Vendrell JF. COVID-19 patients presenting with afebrile acute abdominal pain. Clin Med (Lond). 2020; 20(3):e4–6.

DOI: 10.7861/clinmed.2020-0150

Epub ahead of print. PMID: 32341078; PMCID: PMC7354040.

Park HC, Kim MJ, Lee BH. The outcome of antibiotic therapy for uncomplicated appendicitis with diameters ≤ 10 mm. Int J Surg. 2014;12(9):897-900.

DOI: 10.1016/j.ijsu.2014.07.011

Epub 2014 Jul 12. PMID: 25019230.

American College of Surgeons. COVID-19 Guidelines for Triage of Emergency General Surgery Patients; 2020.

Available:https://www.facs.org/covid-19/clinical-guidance/elective-case/emergency- surgery

Royal College of Surgeons. Updated Intercollegiate General Surgery Guidance on COVID-19. Guidance for surgeons working during the pandemic. Available:https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/

Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009;96(5):473-81.

DOI: 10.1002/bjs.6482

Erratum in: Br J Surg. 2009 Jul;96(7):830. PMID: 19358184.

Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: An open-label, non-inferiority, randomised controlled trial. Lancet. 2011;377(9777):1573-9.

DOI: 10.1016/S0140-6736(11)60410-8

PMID: 21550483.

Borges do Nascimento IJ, Cacic N, Abdulazeem HM, von Groote TC, Jayarajah U, Weerasekara I, et al. Novel Coronavirus Infection (COVID-19) in humans: A scoping review and meta-analysis. J Clin Med. 2020;9(4):941.

DOI: 10.3390/jcm9040941

PMID: 32235486; PMCID: PMC7230636.

Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. Version 2. EClinical Medicine. 2020;21:100331.

DOI: 10.1016/j.eclinm.2020.100331

Epub ahead of print. PMID: 32292899; PMCID: PMC7128617.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus investigating and research team. a novel coronavirus from patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733.

DOI: 10.1056/NEJMoa2001017

Epub 2020 Jan 24.

PMID: 31978945; PMCID: PMC7092803.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9.

DOI: 10.1001/jama.2020.1585

Epub ahead of print.

PMID: 32031570; PMCID: PMC7042881.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223): 497-506.

DOI: 10.1016/S0140-6736(20)30183-5

Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 30.

PMID: 31986264; PMCID: PMC7159299.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med; 2020.

Available:https://doi.org/10.1056/NEJMoa2002032.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y,et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223):507-513.

DOI: 10.1016/S0140-6736(20)30211-7

Epub 2020 Jan 30. PMID: 32007143; PMCID: PMC7135076.

Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929-936.

DOI: 10.1056/NEJMoa2001191

Epub 2020 Jan 31. PMID: 32004427; PMCID: PMC7092802.

Bezerra JA, Pochapin MB, El-Serag HB, Vargo JJ. COVID-19 Clinical insights for our community of gastroenterologists and gastroenterology care providers. Bethesda: American College of Gastroenterology; 2020.

Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020;75:1730–1741.

Available:https://doi.org/10.1111/all.14238

Saeed U, Sellevoll HB, Young VS, Sandbaek G, Glomsaker T, Mala T. Covid-19 may present with acute abdominal pain. Br J Surg. 2020;107(7):e186-e187.

DOI: 10.1002/bjs.11674

Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14(2):185-192.

DOI: 10.1007/s11684-020-0754-0

Ahmed AOE, Badawi M, Ahmed K, Mohamed MFH. Case report: COVID-19 Masquerading as an Acute Surgical Abdomen Am J Trop Med Hyg; 2020.

DOI:10.4269/ajtmh.20-0559

[Published online ahead of print, 2020 Jun 9].

Suwanwongse K, Shabarek N. Successful Conservative Management of Acute Appendicitis in a Coronavirus Disease 2019 (COVID-19) Patient. Cureus. 2020; 12(4):e7834. DOI:10.7759/cureus.7834.

Published 2020 Apr 26

COVID Surg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet. 2020;396(10243):27-38.

DOI: 10.1016/S0140-6736(20)31182-X

Epub 2020 May 29. Erratum in: Lancet. 2020 Jun 9; PMID: 32479829; PMCID: PMC7259900.