Background In early 2020, the COVID‐19 pandemic significantly altered management of surgical patients globally. International guidelines recommended that non-operative management be implemented wherever possible (e.g. in proven uncomplicated appendicitis) to reduce pressure on healthcare services and reduce risk of peri-operative viral transmission. We sought to compare our management and outcomes of appendicitis during lockdown versus a non-pandemic period. Methods All presentations to our department with a clinical diagnosis of acute appendicitis between 12/03/2020 and 30/06/2020 were compared to the same 110-day period in 2019. Quantity and severity of presentations, use of radiological investigations, rate of operative intervention and histopathological findings were variables collected for comparison. Results There was a reduction in appendicitis presentations (from 74 to 56 cases), and an increase in radiological imaging (from 70.27% to 89.29%)( P =0.007) from 2019 to 2020. In 2019, 93.24% of patients had appendicectomy, compared to 71.42% in 2020(P<0.001). This decrease was most pronounced in uncomplicated cases, whose operative rates dropped from 90.32% to 62.5%( P =0.009). Post-operative histology confirmed appendicitis in 73.9% in 2019, compared to 97.5% in 2020 ( P =0.001). Normal appendiceal pathology was reported for 17 cases (24.64%) in 2019, compared to none in 2020 ( P <0.001) – a 0% negative appendicectomy rate (NAR). Discussion The 0% NAR in 2020 is due to a combination of increased CT imaging, a higher threshold to operate, and is impacted by increased disease severity due to delayed patient presentation. This study adds to growing literature promoting routine use of radiological imaging to confirm appendicitis diagnosis. As we enter a second lockdown, patients should be encouraged to avoid late presentations, and surgical departments should continue using radiological imaging more liberally in guiding appendicitis management.

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Efferent loop syndrome has been rarely reported after pancreatoduodenectomy. In those cases that have been reported, the majority presented late and recurrence or peritoneal metastases were found to be the usual causes. Foreign body giant cell reactions (FBGCR) also rarely develop into masses that are large enough to cause problems or mimic malignancy. This report presents a case of a middle-aged female who underwent completion extended cholecystectomy for carcinoma of the gallbladder. Whipple’s pancreatoduodenectomy was also performed at the same surgery due to presence of a hard mass at the cystic duct stump that was densely adherent to the common bile duct and duodenal cap. This was later found to be FBGCR. The patient underwent re-exploration just three weeks later for efferent loop syndrome, the cause of which was again found to be a mass due to FBGCR that was not previously present. Despite a difficult initial treatment phase, the patient is disease free and doing well after two and half years of completing treatment for the carcinoma gallbladder.

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