Background Appendix’ anatomical variations are a rare occurrence which can mislead diagnosis and delay appropriate treatment. Case presentation We present a 9-year-old female patient that came with a clinical picture compatible with acute appendicitis. However, a cecal mass was identified instead of an inflamed appendix during surgery. Therapeutic decisions were extremely challenging due to clinical deterioration and an uncertain etiology. Only the histopathology report revealed the presence of a complete subserosal appendix which was responsible for the entire symptomatology. Here, we review all case reports regarding intramural, intracecal or subserosal appendixes. A discussion of the general approach to this specific case and the importance of consensual diagnostic criteria for these specimens are also presented. At last, an incidental finding is exposed and final treatment options are discussed given the overall presentation. Conclusions Considering these variants would guide physicians towards a more accurate approach to similar clinical pictures and hence an improved long-term prognosis.

In December 2019, an outbreak of a new coronavirus disease (formally known as COVID-19) was first reported in Wuhan, China, and soon spread around the world. On March 11, 2020, COVID-19 was declared as a pandemic by the World Health Organization (WHO). So far, COVID-19 has proven to be a disease with multiorgan involvement, affecting the hematological system as well. Patients with COVID-19, especially those with moderate to severe disease, frequently experience a coagulopathy associated with a high incidence of thrombotic events, which leads to poor outcomes. The pathogenesis of COVID-associated coagulopathy (CAC), is not fully understood yet, although the host inflammatory response to the infection appears to be a crucial element in the development of CAC. IL2, IL-6, IL7, G-CSF, PI10, MIP1, and TNF alpha, among other molecules, act as proinflammatory cytokines that stimulate endothelium damage and alter the coagulation homeostasis. CAC usually manifests as venous thromboembolisms (VTE). While bleeding can also occur, it is a rare form of presentation. Inpatients with COVID-19 must receive thromboprophylaxis, mainly with low-molecular-weight heparin (LMWH); unfractioned heparin can be accepted under certain circumstances. Patients with a diagnosis or high suspicion of VTE should receive the complete doses of anticoagulation treatment and must continue on it for at least three months. Recommendations regarding prophylaxis and treatment may vary among institutions and countries. There is not clear evidence for the regular use of antiplatelet therapy in patients with COVID-19. This review will provide key insights regarding the pathophysiology, clinical manifestations, diagnosis and treatment of COVID-19 and its associated coagulopathy.