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Case Reports
. 2022 Jun 1;24(1):482.
doi: 10.3892/etm.2022.11409. eCollection 2022 Jul.

COVID-19-associated acute appendicitis in adults. A report of five cases and a review of the literature

Vasiliki Epameinondas Georgakopoulou  1 , Aikaterini Gkoufa  1 , Christos Damaskos  2   3 , Petros Papalexis  4   5 , Aikaterini Pierrakou  6 , Sotiria Makrodimitri  1 , Georgia Sypsa  7 , Apostolos Apostolou  1 , Stavroula Asimakopoulou  1 , Serafeim Chlapoutakis  8 , Pagona Sklapani  9 , Nikolaos Trakas  10 , Demetrios A Spandidos  11
Affiliations
Case Reports

COVID-19-associated acute appendicitis in adults. A report of five cases and a review of the literature

Vasiliki Epameinondas Georgakopoulou et al. Exp Ther Med. .

Abstract

The novel coronavirus has negatively affected patients and healthcare systems globally. Individuals with coronavirus disease 2019 (COVID-19) experience a wide range of respiratory symptoms, from mild flu-like symptoms to severe and potentially fatal pneumonia. Some patients report gastrointestinal symptoms, such as nausea, vomiting and abdominal pain in addition to the respiratory symptoms or as a separate presentation. Even though abdominal pain syndrome indicates acute appendicitis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be considered as a possible diagnosis during this pandemic. However, there have been reports of a few cases of acute abdominal pain revealing acute appendicitis associated with SARS-CoV-2 infection. Appendectomy is challenging in COVID-19-infected patients with acute appendicitis as it includes high surgical risks for the patients, as well as hazards for healthcare professionals who are exposed to SARS-CoV-2. The present study reports five cases of adult patients with COVID-19 with simultaneous acute appendicitis. In addition, the present study aims to provide the framework for the diagnosis and management of adult patients with COVID-19 with acute appendicitis.

Keywords: abdominal pain; acute abdomen; acute appendicitis; appendectomy; coronavirus disease 2019.

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Conflict of interest statement

DAS is the Editor-in-Chief for the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article. The other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Case 1. (A) Normal chest X-ray. (B) Ultrasonography revealing a hyperechoic shadowing lesion consistent with an appendicolith. (C) Ultrasonography revealing a dilated appendix, measured up to 0.8 cm in the transverse dimension with surrounding fluid. (D) Hematoxylin and eosin staining; original magnification, x100. The histological analysis revealed acute appendicitis with massive inflammatory infiltrate of the appendicular wall and mesenterium.
Figure 2
Figure 2
Case 2. (A) A chest X-ray revealed mild infiltrates in both lower lung lobes. (B) Abdominal computed tomography revealed mild dilation of the appendix and wall thickening. (C) Hematoxylin and eosin staining; original magnification, x200. The histological analysis revealed acute appendicitis with peri-appendicitis, as well as torsion of an epiploic appendix, with fibrosis in its wall and peripheral deposition of calcium salts. (D) A chest X-ray revealed infiltrates in all lung fields.
Figure 3
Figure 3
Case 3. (A) Normal chest X-ray. (B) An abdominal computed tomography revealed an enlarged appendix, ~12 mm in diameter, with significant wall thickening and stranding of the surrounding fat. (C) Hematoxylin and eosin staining; original magnification, x40. The histological analysis revealed acute appendicitis with a heavily inflamed mucosa with accompanying extensive ulceration and hemorrhage, covered by fibrinopurulent exudate.
Figure 4
Figure 4
Case 4. (A) Normal chest X-ray. (B) An abdominal computed tomography revealed an inflamed appendix originating from the cecum in deep pelvic position. (C) Hematoxylin and eosin staining; original magnification, x400. The histological analysis revealed acute appendicitis with intense neutropilic infiltration of the appendix wall.
Figure 5
Figure 5
Case 5. (A) Normal chest X-ray. (B) An abdominal computed tomography revealed an appendiceal enlargement with intraluminal calcified fecalith and marked inflammatory changes in the surrounding mesenteric fat with possible microperforation. (C) Hematoxylin and eosin staining; original magnification, x200. The histological analysis revealed acute gangrenous appendicitis.
See this image and copyright information in PMC

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