Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgΑ), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.

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The clinical presentation of congenital abnormalities in adult life is a rare condition since they usually make their appearance in early childhood. A combination of two different congenital deformities is even more infrequent, a fact that might complicate the differential diagnosis of acute abdomen. This is a case report of an inflamed Meckel's diverticulum in a 16-year-old male with intestinal malrotation presented in an acute setting, and a review of the literature. The patient presented at the emergency department with an atypical abdominal pain located in the right abdomen and quite elevated inflammatory markers. Computed tomography revealed Meckel's diverticulitis in combination with intestinal malrotation, findings that were confirmed intraoperatively. A partial enterectomy with a side-to-side anastomosis was performed, and the patient was discharged uneventfully. Only a few cases of this combination have been reported in the literature till nowadays. This article indicates the importance of the computed tomography scan in the differential diagnosis of abdominal pain since it might reveal rare clinical entities and determine the further therapeutic plan. Furthermore, it is a reminder that congenital abnormalities might make their clinical appearance not only in early childhood but also in adult life, pointing out the ability of the general surgeon to deal with such cases.