No SARS-CoV-2 detected in the vermiform appendix of a COVID-19 patient with appendicitis: a case report

Abstract

Background:SARS-CoV-2, the virus causing corona virus disease 2019 (COVID-19), has been demonstrated to infect the gastrointestinal tract and might therefore be a source of infection for the surgical team during abdominal operations. One of the most common surgical procedures performed is appendectomy. However, reports of virologic testing of appendiceal tissue specimens in COVID-19 patients are lacking. We sought to determine whether SARS-CoV-2 is present in the appendectomy specimen of a patient with COVID-19. Case presentation:A female patient presented to the emergency department of our tertiary care academic hospital with lower abdominal pain, fever, nausea, and vomiting. She was admitted to the gynecological floor because of suspected pelvic inflammatory disease. Due to worsening symptoms, a laparoscopy was performed the next day and a severely inflamed appendix was detected. Laparoscopic appendectomy was performed without complications. A few hours postoperatively, the patient was tested positive for corona virus disease 2019 (COVID 19). Real-time reverse transcription polymerase chain reaction analysis targeting the SARS-CoV-2 E-gene was performed on the appendectomy specimen. SARS-CoV-2 could not be detected. During her hospital stay, the patient developed mild respiratory symptoms while the postoperative course was otherwise uncomplicated. Conclusions:The absence of SARS-CoV-2 in the appendectomy specimen of our case adds to the preliminary available evidence indicating that appendectomy in COVID-19 patients with mild disease carries probably a low risk of infection by aerosols generated during the procedure.

Microvascular injury in the appendix of a pediatric patient with history of COVID-19 infection: A case report

“…Clinical findings of this syndrome are similar to that of Kawasaki's disease, with sudden fever-most of the time of unknown origin-and multisystem inflammation including heart, lungs, kidneys, liver, skin, eyes, brain, and the GI tracts [3,5,[12][13][14]. As of now, GI involvement appears to be the predominate pattern in MIS-C and seen in 92% of patients [9]. These GI symptoms sometimes mimic infectious GI etiologies, as well as inflammatory bowel diseases, or ischemic bowel disease.…”

“…In the literature, many experiments confirmed that SARS-CoV-2 can infect and replicate in enterocytes [9], and also SARS-CoV-2 was demonstrated in stool specimen. In one study, SARS-CoV-2 was detected within enterocytes in biopsies taken from the esophagus, stomach, duodenum, and rectum of COVID-19 patients with severe disease [9]. But there is limited information regarding COVID-19 and acute appendicitis.…”

SARS-CoV-2 Infection Is Not Associated With Pediatric Appendicitis

“…To date, 4 case reports have attempted to detect CoV2 in surgical samples from appendicitis cases (Table, Supplemental Digital Content 1, http://links.lww.com/INF/E736), and CoV2 in the appendix was detected in 2 of 3 cases, including 1 case in a child. [12][13][14] The fourth case did not directly test appendix tissue but did test peritoneal washings from an appendicitis case which was found to be negative. 15 Our study demonstrated that the total number and complexity of appendicitis cases did not change during the pandemic.…”

Comparison of histopathological findings of patients presenting with acute appendicitis in COVID-19 infected and non-COVID-19 infected patients.

“…GI symptoms occur in 11-64% of COVID-19 positive patients. So huge concern is there about GI problems in COVID-19 patients because almost half of the patients do not show respiratory symptoms 15 . In other research, 733 patients were included in the 2019 cohort, and 422 patients were included in the 2020 cohort.…”